Daflure Heating & Cooling – Application for Employment

Service Technicians
Installers (Including Foremen)
Indoor Air Quality Technicians

Need at least 5 years experience
Need to pass a Service Technician Quiz

You may also download a PDF version of this employment application if you would prefer to print it out for later
submission. Click Here to download the Daflure employment application in PDF format.

First name:
Last name:
Middle initial:
Date:
Address line 1:
Address line 2:
City:
State:
Zip code:
How long at this address? :
Social Security No. :
Home telephone:
Work telephone:
Cell phone:

The positions at Daflure require that, at a minimum, employees be able to 1) Walk
potentially long distances, 2) Be on their feet all day, 3) Be able to lift 25+ pounds in
weight, 4) Be able to reach and lift arms over shoulder level, 5) Have the ability to
look up and/or down for extended periods, 6) Have visual acuity, 7) some positions
require a valid driver's license and insurance.

Based on the Essential Functions above, do you require "reasonable accommodation"
under ADA in order to perform the work of any of Daflure's poistions? If so, what
reasonable accommodation? Please explain in the box below:

Position applied for:
Salary desired:
Hours available to work:
Days available to work:	M	T	W	Th	F	Sat	Sun

Type of employment:	Full-time				Part-time

Date available to start work:
Are you willing to work overtime?	Yes				No

Are you willing to work out of town?	Yes				No

Are there any circumstances that would prevent you from being able to report on
time for work or perform work for Daflure or follow their policies?
Please explain in the box below:

Have you ever applied with our Company before?	Yes	No

If yes, for what position/on what date?
Have you ever been fired from another position?	Yes	No

If so, what Company and why?
Are you over 18 years of age?	Yes	No

Are you a U.S. Citizen?	Yes	No

DO YOU CURRENTLY HAVE:
A current plumbing certification?	Yes	No

A current plumbing inspection license?	Yes	No

A current PA refrigerant certification/license?	Yes	No

A current HVAC certification/license?	Yes	No

Any other certifications/licenses? Please explain in the box below:

School #1
Type of School:
Name of School:
Address:
Years Completed:
Major/Degree:

School #2
Type of School:
Name of School:
Address:
Years Completed:
Major/Degree:

School #3
Type of School:
Name of School:
Address:
Years Completed:
Major/Degree:

How many years of experience do you have in plumbing?
Your plumbing level:	Journeyman	Foreman

Do you have plumbing experience in:	Commercial:
	Single/Residential:
	Multi-Family Units:

How many years of experience do you have in HVAC?
Your HVAC level:	Journeyman	Foreman

Do you have HVAC experience in:	Commercial:
	Single/Residential:
	Multi-Family Units:

Are you EPA certified? :	Yes	No

If yes, What level? :

Employer #1
Employer Name:
Employer Address:
Employer telephone:
Name of Supervisor:
Employment Dates:
Salary:
Position, Title & Duties:
Reason for leaving (specifically):

Employer #2
Employer Name:
Employer Address:
Employer telephone:
Name of Supervisor:
Employment Dates:
Salary:
Position, Title & Duties:
Reason for leaving (specifically):

Employer #3
Employer Name:
Employer Address:
Employer telephone:
Name of Supervisor:
Employment Dates:
Salary:
Position, Title & Duties:
Reason for leaving (specifically):

May we contact your present & previous employers?	Yes	No

Did you complete this application yourself?	Yes	No

If not, name of person who did:
HAVE YOU EVER BEEN CHARGED WITH A FELONY OR MISDEMEANOR?	Yes	No

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?	Yes	No

If the answer is yes, please explain the offenses charged or convicted, the date, the sentence
imposed, and/or other pertinent information in the box below:

Have you ever been in the U.S. Armed Forces?	Yes		No

If so, please list the branch, your dates of service, your rank and your duties in the box below:

If discharged from the U.S. Armed Forces, were you honorably discharged?	Yes		No

If no, please explain in the box below:

	REFERENCES
	List the information for three (3) references for persons not related to you whom you have known at least 1 year.

Name:	Phone Number:	Business:	Years Known:

Do you have personal transportation?	Yes	No

If yes, what type?
Do you have a current, valid driver's license?	Yes	No

Has your driver's license ever been suspended?	Yes	No

If your driver's license has ever been suspended, please explain in the box below:

Driver's License No. :
State Issued:
Expiration Date:
Class:

Do you currently have valid vehicle insurance?	Yes	No

If yes, name of insurer:
Policy number of insurer:
Have you had any motor vehicle accidents in the last three (3) years?	Yes	No

If yes, how many?

If you have had any motor vehicle accidents in the last three (3) years, please describe the
circumstances and if you were cited as a result in the box below:

Have you had any moving violations in the last three (3) years?	Yes	No

If yes, how many?

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