Last Name *

First *

Middle Initial *

Date *

Street Address *

Apartment/Unit Number

City *

State *

ZIP *

Phone *

Email Address *

Date Available *

Desired Salary *

Position Applied For *

Are you a citizen of the United States? *

If no, are you authorized to work in the U.S.?

Have you ever worked for this company? *

If yes, when?

Were you referred to this company by a current or former employee? *

If yes, who?

How did you hear about our company? *

High School

Address

From

Did you graduate?

Degree

From

Did you graduate?

Degree

From

Did you graduate?

Degree

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Most Recent Company *

Phone *

Address *

Supervisor *

Job Title *

Starting Salary *

Ending Salary *

Employed From *

To *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

Job Title

Starting Salary

Ending Salary

Employed From

Reason for Leaving

May we contact your previous supervisor for a reference?

Job Title

Starting Salary

Ending Salary

Employed From

Reason for Leaving

May we contact your previous supervisor for a reference?

Rank at Discharge

Type of Discharge

If other than honorable, explain

When are you available to start work?

Desired Employment Type *

Desired Salary (Per Hour)

What is your ideal position and work schedule?

What are your long-term career goals?

Are you available to work overtime? *

Are you available to work weekends? *

Do you have a valid driver’s license? *

Will you be able to perform the essential job functions for the position you are applying, either with or without reasonable accommodations? *

Have you ever been convicted of a felony? *

If yes, explain

Are you currently out on bail or released on your own recognizance pending trial? *

If yes, explain

Please rate your skills and knowledge from 1-3 in each of the following areas:

(1 is no experience and 3 is expert – not all areas may apply)

Certifications and Licenses:

List equipment brands you are familiar working on:

List your three top areas of expertise (e.g., refrigeration, commercial HVAC, chillers, etc):

List any computer or dispatch software you are familiar with:

Have you ever worked with or used electronic handheld devices to invoice customers and track equipment? *YesNo

Persons with Disabilities/Vietnam Veterans, Disabled Veterans and Other Covered Veterans

The Americans with Disabilities Act (ADA) and Section 503 of the Rehabilitation Act of 1973 prohibit employment discrimination against qualified individuals with disabilities. Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended by the Veterans Employment Opportunity Act of 1998, eliminates barriers of employment for veterans. Our companies willingly compliy with these laws.

Application Information

Please read the following statements and ask for clarification, if needed, before you sign this application. Applicants will be considered regardless of race, color, religion, gender, national origin, citizenship status, sexual orientation, age, marital status, veteran status, or the presence of a medical condition or disability.

I certify that my answers are true and complete to the best of my knowledge. Further, I understand that if hired, I agree to abide by all company policies and procedures, as outlined in the company handbook.

If this application leads to employment, I further understand that false or misleading information in my application or interview may result in my release, regardless of how or when it was discovered. I authorize T&T/Lanco Inc, and/or it’s subsidiaries to investigate and verify all statements and information contained in this application and during my interview (if applicable). I release all liability from anyone supplying such information, as well as T&T/Lanco Inc, and it’s subsidiaries from any and all liability that might result from conducting an investigation.

If hired, I further understand that:

My employment would be at will, and that I could be terminated at any time, with or without cause or notice at the option of the employer or myself. This employment application will become part of the terms and conditions of employment.

Electronic Signature *

Date *

Office Hours

20 Summit Avenue Reading, PA 19605

7:00AM - 3:00PM, Monday - Friday

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(610) 921-0661

24/7 On Call Answering Service

Employment Application