Chuck's Heating & Air Conditioning

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Online Employment Application Form

Step 1 of 6

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Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Driver's License Number
State and Expiration Date
Are you a citizen of the United States?
- Yes
- No

Job Interests / Skills
Position(a) applied for*
Salary Desired
Have you applied for a position here before?
- Yes
- No
If yes, when?
Type of Employment Requested
- Full Time
- Part Time
Do you have your own tools?
- Yes
- No
Date you could begin working
Do you have a problem with heights?
- Yes
- No
Summarize and other special skills or qualifications

Education
High School Name, City, State
Studied, # of years, GPA
Degree, diploma, certificate, honors received
College Name, City, State
Studied, # of years, GPA
Degree, diploma, certificate, honors received
Professional License Name, City, State
Studied, # of years, GPA
Degree, diploma, certificate, honors received

Employment History (list most recent first)

Employer 1
Name of Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor and Title
Your Title
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Starting Salary
Ending Salary
Work Performed
Reason for Leaving
Employer 2
Name of Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor and Title
Your Title
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Starting Salary
Ending Salary
Work Performed
Reason for Leaving
Employer 3
Name of Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor and Title
Your Title
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Starting Salary
Ending Salary
Work Performed
Reason for Leaving

References

Reference 1
Name
First Last
Relationship
Phone
Reference 2
Name
First Last
Relationship
Phone
Reference 3
Name
First Last
Relationship
Phone

Acknowledgement
*
- By checking this box, I certify that the answers given by me in this application are correct to the best of my knowledge. I understand that any falsification of this applicaUon, whether willingly or accidental, is grounds for disqualification of employment consideration, or dismissal from employment if I am hired. authorize the company to contact any and all of the references I have listed above to obtain previous employment information or any other pertinent information that they may have. Further, I release the above mentioned references from any and all liability for any damages that may result from information collected by this company. I authorize this company to check with the OMV in regards to my driving record. Verification of eligibility to work in the United States must be satisfied for an offer to be made.
Date of Acknowledgement*
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Chuck’s Heating and Air Conditioning, Inc. is a family owned business serving the Colchester, VT area since 1977. Whether you need climate control, plumbing, or a new stainless kitchen counter, Chuck’s is the place to go!
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416 Roosevelt Highway
Colchester, VT 05446
802-655-1489 | 800-655-1489

Office Hours:
Monday-Friday 7:00-4:30

© 2023 Chuck's Heating & Air Conditioning, Inc.