BROWN HEATING & COOLING CO., INC. APPLICATION FOR EMPLOYMENT It is the policy of Brown Heating & Cooling Co., Inc. to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability or any other condition protected by law. No question on this application is asked for the purpose of limiting or excluding any applicant’s consideration for employment because of his or her race, color, religion, sex, national origin, age, disability or any other condition protected by law. Please fill out this Application in its entirety. Use N/A when not applicable. PERSONAL INFORMATION Name _________________________________________________________________ Address________________________City_______________State_____Zip___________ Telephone #

________________________Date of Birth _______________________

Social Security # ______________________ Driver’s License # ___________________ Type of Work Desired ____________________________________________________ Wage Expected ______________________ Date Can Start ______________________ Have you ever applied to or worked for this Company? Yes ________ No ___________ If so, When, Position Held _________________________________________________ If you have relatives employed by this company, please give names: ______________________________________________________________________ Desire Full or Part-time Work: ______________________________________________ Are you either a U. S. citizen or legally authorized to work in the United States? Yes _______________ No ______________ (Your will be required to provide proof of citizenship or right to work status at time of hire) Have you ever been convicted of a crime? Yes ________ No _________ What Offense? Where? When?______________________________________________ ______________________________________________________________________

EDUCATION Circle Highest Grade Completed: Grade School/High School 1 2 3 4 5 6 7 8 9 10 11 12 College/Graduate School 1 2 3 4 5 6 High School: Name _____________________________ Location _______________________ Major Field ________________________ Degree _________________________ Dates Attended _____________________________________________________ College: Name ____________________________ Location ________________________ Major Field ________________________ Degree _________________________ Dates Attended _____________________________________________________ Graduate School: Name ___________________________ Location _________________________ Major Field _______________________ Degree __________________________ Dates Attended ____________________________________________________ Technical or Vocational School Name _________________________ Location ___________________________ Major Field _____________________ Degree ____________________________ Dates Attended _____________________________________________________

Type

Professional Licenses and/or Certifications Organization/State Issued Date Issued Number

________________________________________________________________ ________________________________________________________________ (2)

Previous Work Experience Present or last Employer: _____________________________________________ Address: _________________________________________________________ Telephone # _________________ Date of Employment _____________________ Position/Duties ___________________________________ Salary: ___________ Reason for Leaving: _________________________________________________ _________________________________________________________________

Employer: ________________________________________________________ Address: _________________________________________________________ Telephone # _________________ Date of Employment _____________________ Position/Duties ____________________________________ Salary: ___________ Reason for Leaving __________________________________________________ _________________________________________________________________

Employer: _________________________________________________________ Address: __________________________________________________________ Telephone # _________________ Date of Employment ______________________ Position/Duties ____________________________________ Salary ____________ Reason for Leaving ___________________________________________________ __________________________________________________________________

(3)

Military Service

Were you in the U.S. Armed Forces? ___________________________________ If yes, what branch? _________________________________________________ Date of duty: From _________________________ To ______________________ Rank of Discharge? __________________________________________________ Special Training or Duties while in military __________________________________ __________________________________________________________________ Are you currently a member of a reserve unit? _______________________________ Personal References (Do not list relatives or former employers) Name

Address

Telephone #

_________________________________________________________________ _________________________________________________________________ Applicant Certification I certify that all information given on this application is true, correct, and complete. I understand that misrepresentation or omission of facts will be cause for cancellation of my consideration for employment, or dismissal, if employed. I authorize any inquiry to be made on any information contained in this application, if I am considered for employment. I understand that this is an application for employment and that no employment contract is being offered; and I understand that if employed, such employment is for an indefinite period and is subject to change in wages, benefits, and operating policies. I further understand that an offer of employment will be conditioned upon the successful completion (if Brown Heating & Cooling chooses) of a physical examination, a MVR (motor vehicle report), a background check, a criminal search, a previous employer review, a credit report, a workers compensation report, a drug test and that continued employment will be subject to the terms of the Company’s Drug and Alcohol Policy. Signature:________________________________________ Date:______________ This application will remain active for ______ days.

Physical and Medical Information In responding to the following questions, please refer to the job description for the position for which you are seeking employment. ** Do you have any physical or mental condition which would substantially interfere with your ability to perform the essential duties of the job for which you have applied or for which you will need reasonable accommodation? YES_________ NO ________ If yes, please describe: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Name, address, and phone number of physician having records and /or knowledge of your medical history. Name ________________________________Phone# _______________________ Address ____________________________________________________________ May we contact your physician for information on your medical history? _____________ Will you authorize, if necessary, a release of your medical records to assist us in determining your fitness to perform any physical activities related to the job(s) for which you are applying? YES_______________ NO ____________ ** The responses to these questions will not be taken into consideration until after a conditional job offer has been made. Emergency Notification Name: ___________________________________________________________ Address:__________________________________________________________ __________________________________________ Phone # _______________

(5)

RELEASE AUTHORIZATION

In connection with my application for employment, I understand that several consumer reports may be requested and may include information as to my character, work habits, credit, academic credential verification, job performance, experience and reasons for termination. Further, I understand that you may be requesting information concerning my workers’ compensation claims, motor vehicle operations history and criminal history from various private and public sources along with other public records that are available. I HEREBY AUTHORIZE AND RELEASE FROM ALL LIABILITY, WITHOUT RESERVATION, BROWN HEATING AND COOLING/SENTRY LINK/EMPLOYMENT SCREENING SERVICES AND ANY LAW ENFORCEMENT AGENCY, ADMINISTRATOR, STATE/FEDERAL AGENCY, INSTITUTION,INFORMATION SERVICE BUREAU, EMPLOYER, EMPLOYEE, INSURANCECOMPANY OR PERSONS GATHERING OR FURNISHING THE ABOVE INFORMATION. I further acknowledge that a telephone facsimile (fax) or photographic copy of this release will be as valid as the original. According to the Fair Credit Reporting Act, I am entitled to know if employment will be and is ultimately denied because of information obtained by my prospective employer or from a consumer reporting agency. If so, I will be so advised by this employer and be given the name of the agency or source of information.

Print Name: ____________________________________________________________ Last First Middle Initial Maiden/Previous Name(s)__________________________________________________

Date of Birth______________ Social Security Number __________________________

Address _______________________________________________________________ Driver’s License # _____________________________ State Issued_______________ (Necessary for Motor Vehicle Reports) ______________________________________________________________________ Applicant’s Signature Today’s Date

TO APPLICANTS FOR EMPLOYMENT AT BROWN HEATING & COOLING Due to the requirements made by the State of Alabama’s Workman’s Compensation and Brown Heating and Cooling’s Vehicle Insurance Company, we are required to do drug testing and motor vehicle reports, on all employees and applicants for employment. Therefore, a charge of $45.00 for drug testing is required upon approval for employment. If report is acceptable, a total refund will be issued after thirty (30) days of employment. I understand the information as stated above and agree to pay $45.00 upon consideration for employment.

Signed: ________________________________ Date:____________________

IF YOU ARE BEING HIRED THROUGH A TEMP AGENTCY, THEY WILL DO THE DRUG TESTING IF YOU ARE CONSIDERED FOR HIRE. OFFICE PERSONAL DO NOT DRIVE COMPANY VEHICLES AND THEREFORE NO MOTOR VEHICLE REPORT IS REQUIRED.