AirClean® Systems is an equal opportunity employer, committed to the hiring, advancement and fair treatment of individuals without regard to race, color, religion, sex, sexual preference, age, national origin, ethnicity, disability or veteran status, or any other protected status designated by federal, state or local law.

Personal Information
Your Name:
  
Address:
  
Address (Cont):
  
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State:
  
Postal Code:
  
Phone:
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Fax:
  
Email:
  
Referred By:
 
Employment Desired
Date you can start
  
Are you currently employed?

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If yes, may we contact your employer?
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Employer's Telephone Number:

Have you ever applied with ACS before?
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Salary Range you require:
  
Education
 
Name/Location of School
Years Attended
Did You Graduate
Subjects Studied
Grammar
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High School
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College
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Trade/Business/
Correspondence School
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Special Skills or Training that are work related.
Have you served in the US Military or Naval Service?
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Have you been convicted of a felony within the last 5 years?
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If yes, explain
(This will not necessarily exclude you from consideration):

Employment History
Date
Name & Address of Employer
Salary
Position
Reason for Leaving
From:
To:
From:
To:
From:
To:
From:
To:
References
Name
Address
Relationship
Years Known
Authorization
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing an signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

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3248 Lake Woodard Drive Raleigh North Carolina 27604 USA
Phone: (919) 255-3220 Toll Free: (800) 849-0472 Fax (919) 255-6120 info@aircleansystems.com


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