Applicant Information
Location: Philadelphia, Pennsylvania It is the policy of Heiler Painting to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, creed, age, sex, gender, gender identity, ancestry, national origin, marital status, civil union status, domestic partnership status, veteran’s status, sexual orientation, disability, genetic information, citizenship, or any other protected status. I also understand that Heiler Painting will consider reasonable accommodations for any applicant or employee with a handicap or disability who requests a reasonable accommodation during the application/interview process or during employment.
Applicant Full Name *
Street Address *
City *
State * --- Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
Zip Code *
Number of Years at This Address *
Home Phone *
Mobile Phone *
Email Address *
Are You 18 Years or Older? * --- Yes No
If hired, are you able to submit proof that you are legally eligible for employment in the United States? * --- Yes No
Do you have a valid driver’s license? * --- Yes No
How did you hear about us? * --- Facebook/Instagram Indeed Craigslist Business Card Saw Our Vans Paint Store Friend or Family Member Other
Referral Name
Job Information Job Position Applied For * --- Intern Laborer Marketer Office Administrator Painter Painter Foreman Sales Person
Employment Type * --- Full Time Part Time
Are you able to work weekends if necessary? * --- Yes No
If no, please state any limitations
Desired Salary (e.g $/per hour) *
Desired Start Date *
Have you applied to our company previously? * --- Yes No
If yes, when?
Do you have any friends or relatives who work here? If yes, please list here. *
Are you able to perform the essential functions of the job position you seek with or without reasonable --- Yes No
What reasonable accommodation, if any, would you request? *
Applicant Skills Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and check off the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
SALES Years of Experience *
Rating (e.g. 5 is the highest rating) * --- 1 2 3 4 5
OTHER SKILLS Please describe other skills you have in more detail *
Can you speak/read any language other than English? * --- Yes No
If yes, please describe in more detail
Applicant Employment History List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.
EMPLOYER #1 Employer Name *
Supervisor Name *
Street Address *
City *
State * --- Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
Zip Code *
Job Title *
Reason for Leaving *
Start Date *
End Date *
EMPLOYER #2 Employer Name
Supervisor Name
Street Address
City
State --- Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
Zip Code
Job Title
Reason for Leaving
Start Date
End Date
EMPLOYER #3 Employer Name
Supervisor Name
Street Address
City
State --- Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands
Zip Code
Job Title
Reason for Leaving
Start Date
End Date
Applicant Education and Training
HIGH SCHOOL Name of High School *
City/State *
Did You Graduate? * --- Yes No
Years Attended *
COLLEGE Name of College
City/State
Degree --- Yes No
Years Attended
OTHER Please describe other education, training, and relevant skills you have in more detail
Applicant References List any two business references (non- relatives) who would be willing to provide a reference for you.
REFERENCE #1 Name *
Phone Number *
Email Address *
Relationship *
REFERENCE #2 Name *
Phone Number *
Email Address *
Relationship *
Additional Information Do you have a laptop? --- Yes No
Have you ever been convicted for theft or any sort of violent crime? --- Yes No
Why do you enjoy sales and marketing?
If you have read through our website do any of our core values resonate with you? If so, why?
What is MOST important to you when choosing a company? --- Money Stability Growth Opportunities Benefits Company Culture Other
What is the Square root of 7025?
Where was our nation's capital in 1789? --- Washington DC Philadelphia New York Boston
Tell us about your most memorable sale
Please share a time when you persevered through a difficult situation
Which part of your education have you enjoyed most?
What area would you enjoy furthering your education?
What is one of your favorite movies/TV shows?
What do you do in your free time?
What is your favorite book and why?
Where do you see yourself in 5 years?
Certification I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Heiler Painting to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its CEO, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Heiler Painting, except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.
Electronic Signature *
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS