One Tec Air Avenue, Willow Springs, Illinois 60480 USA - Phone: (708) 839-1400 - Fax: (708) 839-0035
print and fax or email to HR@TECAIRINC.COM

APPLICATION FOR EMPLOYMENT

(Pre Employment Questionnaire) (An Equal Opportunity Employer)

Please read carefully and ANSWER ALL QUESTIONS if you want to be considered for employment.

PERSONAL INFORMATION Date:__________________________

Name: ___________________________________________ Social Security Number: __________

Present Address: _____________________________________________________________________

Permanent Address: __________________________________________________________________

Phone Number: _____________________________________________________________________

If any, what languages do you speak fluently? ______________________________________________

Read? ______________________________________________

Write? ______________________________________________

How did you hear of employment opportunities at Tec Air?

Newspaper:

Southtown ________ Chicago Sun Times ________ Tribune________ Shopper _______

Bulletin Board (Where) ____________________________________________________

Walk in _______________

Relative or Friend at Tec Air (Name) _________________________________________

Other __________________________________________________________________

What shift are you interested in? 1^st Shift (7:00am-3:00pm) _______________

(Please Check Ö ) 2^nd Shift (3:00pm-11:00pm) ______________

3^rd Shift (11:00pm-7:00am) ______________

What position are you applying for?______________________________________

Circle One: Full Time Part Time

EDUCATION	Name and Location of School	*NO. of Years Attended	*Did you Graduate?	Subjects Studied
Grammar School
High School
College
Trade, Business or Correspondence School

*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

GENERAL

Please list subjects of special study or research work. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EMPLOYMENT HISTORY

PLEASE LIST BELOW YOUR LAST FOUR EMPLOYERS, BEGINNING WITH THE MOST CURRENT.

DATE MONTH AND YEAR	NAME AND ADDRESS OF EMPLOYER	SALARY $/HR.	POSITION	REASON FOR LEAVING
From:_______________ To:
From:_______________ To:
From:_______________ To:
From:_______________ To:

REFERENCES

PLEASE GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN FOR AT LEAST ONE YEAR.

NAME	ADDRESS	BUSINESS	YEARS ACQUANINTED
1.
2.
3.

DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT LIMIT YOU FROM PERFORMING ANY WORK FOR WHICH YOU ARE BEING CONSIDERED? Yes No

IF YES, WHAT CAN BE DONE TO ACCOMMODATE YOUR LIMITATIONS?

IN CASE OF EMERGENCY

PLEASE NOTIFY

Name: ____________________________ Address _______________________________________ Phone No. ( )____________

"I CERTIFY THAT ATHE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIEFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL..

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INVORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, 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 ANY PRIOR NOTICE."

SIGNATURE: _________________________________________________________ DATE: _____________________________

If you are called to report for work, be sure to bring your Social Security card and proof of minimum age (you must be at least 18 years of age).

TO ALL PROSPECTIVE EMPLOYEES:

Upon reporting for your first day of work you must bring your social security card and a photo ID.