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By submitting this form and signing up for texts, you consent to receive text messages from Patriot Electric, Heating and Cooling at the number provided, including messages sent by the auto dialer. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP or clicking the unsubscribe link (where available), and no further messages will be sent. Reply HELP for help. See Privacy Policy & Terms.

Application Information
First Name

Date of Application:

Employment Position
Position(s) applying for:

How did you hear about this position?

On what date can you start working if you are hired?

Personal Information
Are you 18 years of age or older?

Yes No

Are you a U.S. citizen or approved to work in the United States?

Yes No

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test?

Yes No

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes No

Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying:

Education and Training
High School Name

Location (City, State)

College/University Name

Location (City, State)

Vocational School/Specialized Training Name

Location (City, State)

Military
Are you a member of the Armed Services?

Yes No

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment
Employer #1
Employer Name

Employer Street Address

Employer #2
Employer Name

Employer Street Address

Employer #3
Employer Name

Employer Street Address

AT-WILL EMPLOYMENT
The relationship between you and the Patriot Electric Heating and Cooling is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause,with or without notice, by you or the Patriot Electric Service. No representative of Patriot Electric Servicehas authority to enter into any agreement contrary to the foregoing "employment at will" relationship.You understand that your employment is "at will," and that you acknowledge that no oral or writtenstatements or representations regarding your employment can alter your at-will employment status,except for a written statement signed by you and either our Executive Vice-President/Chief OperationsOfficer or the Company's President.

Licenses and Certifications

By submitting this form and signing up for texts, you consent to receive text messages from Patriot Electric Heating and Cooling at the number provided, including messages sent by the auto dialer. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP or clicking the unsubscribe link (where available), and no further messages will be sent. Reply HELP for help. See Privacy Policy & Terms.

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