Application Form

Name: Kozy Heat Fireplaces
Address: 204 Industrial Park Drive, Lakefield, MN, 56150, US
Telephone: 800-253-4904
Price range: $

Kozy Heat Fireplace

APPLICATION FOR EMPLOYMENT

We consider applicants for all postions without regard to race, color, religion, creed, gender, national origin, age disability, marital or veteran status, sexual orientation, or any other legally protected status.
PERSONAL INFORMATION
Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number
EMPLOYMENT DESIRED

Days/Nights (circle one) Full-Time/Part-Time (circle one)
Position(s) applied for
Date you can start
Salary Desired
Do you seek full or part-time employment
Have you even been convicted of a felony ?
- Yes
- No
If Yes, please explain
Are you currently employed
May we contact you present employer?
- Yes
- No
If No, please explain
Have you ever been terminated from employment ?
- Yes
- No
If Yes, Please explain. Please note this will not exclude you from consideration for employment
EDUCATIONAL HISTORY
High School - Name and Address of School
High School - Course of Study
High School - Years Completed
High School - Diploma / Degree
College - Name and Address of School
College - Course of Study
College - Years Completed
College - Diploma / Degree
Other (Specify) - Name and Address of School
Other (Specify) - Course of Study
Other (Specify) - Years Completed
Other (Specify) - Diploma / Degree
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
PERSONAL REFERENCES

Please list 3 non-relatives whom you have known for at least one year

1
Name
Phone Number
Relationship
Years Known
Address
City
State
Zip
2
Name
Phone Number
Relationship
Years Known
Address
City
State
Zip
3
Name
Phone Number
Relationship
Years Known
Address
City
State
Zip
PREVIOUS EMPLOYMENT

Start with your present or last job and work your way back. Include any job related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1
Employer
Dates Employed - From
Dates Employed - To
Work Performed
Address
Telephone Number(s)
Hourly Rate / Salary - Starting
Hourly Rate / Salary - Final
Reason for Leaving
Job Title
2
Employer
Dates Employed - From
Dates Employed - To
Work Performed
Address
Telephone Number(s)
Hourly Rate / Salary - Starting
Hourly Rate / Salary - Final
Reason for Leaving
Job Title
3
Employer
Dates Employed - From
Dates Employed - To
Work Performed
Address
Telephone Number(s)
Hourly Rate / Salary - Starting
Hourly Rate / Salary - Final
Reason for Leaving
Job Title
4
Employer
Dates Employed - From
Dates Employed - To
Work Performed
Address
Telephone Number(s)
Hourly Rate / Salary - Starting
Hourly Rate / Salary - Final
Reason for Leaving
Job Title
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. Including, but not limited to, disclosure of employer's personell files regarding any disciplinary and/or termination events.

I understand and agree that my employment is "At Will". I understand that false or misleading information given in my application or interview(s) may result in termination.

I understand and agree that 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 previous notice.
Date
Signature
DO NOT WRITE BELOW THIS LINE - FOR PERSONNEL DEPARTMENT USE ONLY
Interviewed By
Interview Date
Employed
Date of Employment
Job Title
Hourly Rate/Salary
By
Name and Title
Date

Application Form

Kozy Heat Fireplace

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATIONAL HISTORY

Other Qualifications

PERSONAL REFERENCES

1

2

3

PREVIOUS EMPLOYMENT

1

2

3

4

DO NOT WRITE BELOW THIS LINE - FOR PERSONNEL DEPARTMENT USE ONLY

By

PRODUCTS

Resources

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