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APPLICATION FOR EMPLOYMENT

Mercury Air Conditioning & Heating

1465 Countryshire Ste. #102

Lake Havasu City, AZ 86403

Ph # (928) 854-4101

Fax # (928) 854-1444

Lic. # K-39 190167

An Equal Opportunity Employer

Position Applying for:_______________________________________________________

Name: ___________________________________________________________________

LastFirstMiddle

Address:  _________________________________________________________________

    Street/Box    City             StateZip

Social Security Number: _____________________

Telephone:  __________________             __________________________

       Home                      Office

Are you under age 18:        Yes                   No

Are you legally eligible to be employed in the United States:           Yes              No

Employment for which you are available:

  Full-Time        PermanentSeasonal

  Part-Time        Temporary (Less than 6 months)

When could you begin employment:

  Now        Beginning on ______________

  After ________waiting days notice to current employer

May we contact your current or most recent employer regarding your qualifications?

                         Yes                 No

Education and Training

Circle last year of education completed.  For high school diploma or GED circle “12”

1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  plus

Please list name of school and decrees completed.  Please indicate diploma, GED or BS/BA

LocationGraduatedOr credit hoursMajor(s)

High School________________________________

College/University________________________________________________

Graduate School________________________________________________

Business or Vocational SchoolInternships:____________________________________________________________

Additional Training (workshops, seminars, apprenticeships, military or other training).  Include approximate hours or days

of training.

_____________________________________________________________________________________________________

List any relevant licenses or certificates:

___________________________________________________________________________________________________

Employment

1.Current or Most Recent Position:

Dates of Employment:  From (mo/yr)________ to (mo/yr) _______   Total years:_____Months:________

Job Title:________________________________   Starting Salary:___________  Last Salary:_________

Employer:_______________________________________Type of business:_______________________

Employer’s Address: ________________________________   Phone: ___________________________

Supervisor’s Name and Title:_____________________________________________________________

Number of employees you supervised: ______________

Average hours worked per week:  1-10_______       11-20________     21-30 ________    31-40_______

Reason for Leaving: ____________________________________________________________________

Complete description of duties:___________________________________________________________

______________________________________________________________________________________

2.Next Previous  Position:

Dates of Employment:  From (mo/yr)________ to (mo/yr) _______   Total years:_____ Months:________

Job Title:________________________________   Starting Salary:_____________  Last Salary:_________

Employer:_______________________________________Type of Business:________________________

Employer’s Address: ________________________________   Phone: _____________________________

Supervisor’s Name and Title: ______________________________________________________________

Number of employees you supervised: ______________

Average hours worked per week:  1-10_______       11-20________     21-30 ________    31-40_________

Reason for Leaving: _____________________________________________________________________

Complete description of duties:____________________________________________________________

_______________________________________________________________________________________

3.Next Previous  Position:

Dates of Employment:  From (mo/yr)________ to (mo/yr) _______   Total years:_____ Months:________

Job Title:________________________________   Starting Salary:_____________  Last Salary:_________

Employer:_______________________________________Type of Business:________________________

Employer’s Address: ________________________________   Phone: _____________________________

Supervisor’s Name and Title: ______________________________________________________________

Number of employees you supervised: ______________

Average hours worked per week:  1-10_______       11-20________     21-30 ________    31-40_________

Reason for Leaving: _____________________________________________________________________

Complete description of duties:____________________________________________________________

_______________________________________________________________________________________

4.Next Previous  Position:

Dates of Employment:  From (mo/yr)________ to (mo/yr) _______   Total years:_____ Months:________

Job Title:________________________________   Starting Salary:_____________  Last Salary:_________

Employer:_______________________________________Type of Business:________________________

Employer’s Address: ________________________________   Phone: _____________________________

Supervisor’s Name and Title: ______________________________________________________________

Number of employees you supervised: ______________

Average hours worked per week:  1-10_______       11-20________     21-30 ________    31-40_________

Reason for Leaving: _____________________________________________________________________

Complete description of duties:____________________________________________________________

______________________________________________________________________________________

Additional Space.  Use this page to complete information given elsewhere on this form.  If you still need

more space, attach additional sheets.  You may also use this space to summarize other pertinent education

or experience that qualifies you for the position for which you are applying.