Employment Application - Winona Heating & Ventilating

I understand that, should I be offered employment, it will be contingent on my successfully passing a pre-employment physical, drug test, criminal background check, and a motor vehicle records review to confirm insurability with WHV’s insurance carrier.

I authorize investigation of all statements contained herein and the references listed, to give you any and all information, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

"*" indicates required fields

Position Applying For*

HVAC

Roofing

Service

Piping/Plumbing

Other

If other please specify.*

Date of Application

Name*

First Middle Last

Phone Number*

Email*

Are You 18 years Of Age Or Older?*

Yes

Present Address

Address*

Street Address City State ZIP Code

Permanent Address

My present address is my permanent address.

Address

Street Address City State ZIP Code

EDUCATION

Education History - List High School and any post High School education.

Type of School

Name and Location of School

Number of Years Attended

Graduated?

Subject Studies

Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, vocational schools, or trade schools

GENERAL INFORMATION

Yes

In Case of Emergency, Notify (Name, Address, and Phone Number)

PERSONAL OR BUSINESS REFERENCES

Give The Name of Three People Not Related To You Whom You Have Known At Least One Year

Add 3 References

Name

Address

Business

Phone Number

Years Aquainted

Click the + button on the right to add additional references

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal and I have read the conditions of employment above.*

I certify by checking this box

Resume

Max. file size: 50 MB.

If you have an electronic version (Word, PDF, etc.) of your resume, you may attach it here.

APPLICATION FORM WAIVER

In Exchange for the consideration of my job application by Winona Heating and Ventilating Co.(WHV Inc.) (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the postion applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment , or to confer any right to remain an employee of WHV Inc. or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and WHV inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. The physical exam includes strength testing, as a pass or fail evaluation conducted by Occupational Health staff at Winona Health or other similar facilities that may be located in your work region.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I also understand that a Motor Vehicle Report (MVR) may be conducted if I have the need to drive a company vehicle. The attached MVR form, completed by me, authorize the records search.

A Criminal Background Search may be conducted. Do you wish to receive a copy?*

Yes

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICATION FORM WAIVER.*

The information in this application is accurate and I have read, understand and agree to the above Application Form Waiver.

Today's Date*

This Company is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

MOTOR VEHICLE RECORD DISCLOSURE AND RELEASE

In connection with my ongoing employment or my application for employment, should I have or secure a position with WHV Inc., I understand that a motor vehicle record which contains public record information may be requested. I further understand that such report(s) will contain personal information concerning my driving record from federal, state, and other agencies which maintain such records, as well as independent services that provide driving record information.:

I authorize, without reservation, any party or agency contacted to furnish the above mentioned information to: WHV Inc.

I hereby authorize procurement of my motor vehicle record report. If hired, this authorization shall remain on file and shall server as ongoing authorization for you to procure such reports at any time during my employment.

WHV's commercial auto insurer and agent will also use this information in conjunction with loss control and safety review efforts.

If being offered employment in Minnesota, and a MVR records check is performed, do you want a copy of your MVR record mailed to you?*

Yes

Print your Full Legal Name (include Middle Initial)*

First Middle Last

Date of Birth*

DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE DISCLOSURE AND RELEASE*

The information in this application is accurate and I have read, understand and agree to the above Disclosure and Release.

46394

Present Address

Permanent Address

EDUCATION

GENERAL INFORMATION

EMPLOYMENT HISTORY

Former Employers #1

Former Employers #2

Former Employers #3

Former Employers #4

PHYSICAL RECORD

PERSONAL OR BUSINESS REFERENCES

APPLICATION FORM WAIVER

MOTOR VEHICLE RECORD DISCLOSURE AND RELEASE

Winona

Rochester

La Crosse

Services

Company