Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best Phone to Reach You

(###)

###

####

Are you legally eligible for employment in this country?

Yes

No

If you are under 18, can you furnish a work permit?

(Proof of U.S. citizenship or immigration status will be required upon employment.)

Yes

No

Have you ever been employed by Air Assurance Company before?

Yes

No

Type of employment desired?

Full-Time

Part-Time

Seasonal

Temporary

Other

Have you ever been convicted of a felony?

Yes

No

Do you hold an active Journeyman's License? State of license?

I do hold an active Journeyman's License

I don't hold an active Journeyman's License

I do hold a State of Oklahoma Journeyman's License

I do not hold a State of Oklahoma Journeyman's License

I hold an Apprentice License

Referral Source

Walk In

Employee

Advertisement

Employment Agency

Other

Graduated

Yes

No

Graduated

Yes

No

Graduated

Yes

No

Graduated

Yes

No

If skilled craft, are you registered in an apprenticeship program?

Yes

No

Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone 1

(###)

###

####

May we contact for reference?

Yes

No

Address 2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone 2

(###)

###

####

May we contact for reference?

Yes

No

Address 3

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone 3

(###)

###

####

May we contact for reference?

Yes

No