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DAIKIN AMERICA, INC. APPLICATION FOR EMPLOYMENT

Please provide only information sought. Providing information not sought or otherwise defacing the application will immediately disqualify the applicant from consideration.

Daikin America, Inc. (hereinafter “DAI” and together with any affiliates collectively “Daikin”) is an equal opportunity employer. It is our policy and practice to provide equal employment opportunities to all applicants and employees without regard to unlawful discrimination based on race, color, religion, sex, sexual orientation, national origin, age, veteran or reservist status, marital status, disability or any other category protected by law.

This policy applies to all aspects of the employment relationship, including hiring and all terms, conditions, and privileges of employment.
PERSONAL INFORMATION
Name*
First Middle Last
Present Address*
Street Address Address Line 2 City State ZIP Code
Permanent Address
Street Address Address Line 2 City State ZIP Code

If different from above
Primary Telephone*
Secondary Telephone
Email*
Are you over 18 years of age?*
- Yes
- No
Can you furnish proof of your eligibility to work in the United States?*
- Yes
- No
Referral Source (How did you hear about us?)
GENERAL INFORMATION
Location Applied For*
Position Applied For
Orangeburg, NY
Position Applied For
Decatur, AL
Position Applied For
Decatur, AL Technical Center
Position Applied For
Detroit, MI
Position Applied For
Hanover, MA
Position Applied For
San Jose, CA
Position Applied For
Work From Home
Position Applied For
Desired Pay*
Seeking Work*
- Full-Time
- Part-Time
- Temporary
Available Start Date*
MM slash DD slash YYYY
Days Available*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Can you work rotating shifts?*
- Yes
- No
Have you previously worked for Daikin?*
- Yes
- No
Position Held
Start Date
MM slash DD slash YYYY
Ending Date
MM slash DD slash YYYY
Reason for Leaving
Do you know anyone who works for Daikin?*
- Yes
- No
If Yes, whom?
Do you have any relatives who work at Daikin?*
- Yes
- No
If Yes, whom, and how are you related?
Have you ever pleaded “guilty” or “no contest” to, or been convicted of a crime?*
- Yes
- No
If yes, please provide date(s) and details:
*PLEASE NOTE: A conviction for a criminal offense will not automatically disqualify you from employment with DAI. DAI will consider the nature and gravity of the offense, the time that has passed since the conviction, and the nature of the position sought with DAI.
EDUCATION INFORMATION
High/Trade School
Name Location Grade/Degree
College/University
Name Location Grade/Degree
Graduate School
Name Location Grade/Degree
EMPLOYMENT HISTORY
Starting with your most recent employer, provide the following information
Employer*
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Your Job Title*
Supervisor*
First Last
May we contact?*
- Yes
- No
Reason for Leaving*
Your Responsibilities*
Employer
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Your Job Title
Supervisor
First Last
May we contact?
- Yes
- No
Reason for Leaving
Your Responsibilities
Employer
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Your Job Title
Supervisor
First Last
May we contact?
- Yes
- No
Reason for Leaving
Your Responsibilities
If you are presently employed, state why you desire a change in job:*
Other specific skills, experience, abilities and knowledge, which help qualify you for the position applied for:*
READ CAREFULLY BEFORE SIGNING
I authorize Daikin America, Inc. (DAI) to investigate all information provided above and to obtain additional information, if necessary, including a criminal background and pre-employment screenings. I understand that if employed, I am an employee-at-will, and that either DAI or I may terminate my employment at any time, with or without cause and with or without notice. I further understand that no representative or agent of DAI, other than the President by written document has any authority to enter an agreement of employment for any specified period of time or otherwise to alter or modify that at-will employment relationship, and that any agreement with the President which does alter or modify employment-at-will relationship must be in writing and signed by the President.

I understand that completion of this application or other steps in the DAI hiring process is not a guarantee of employment with DAI, and that any offer of employment is an offer of employment at will. I understand that any offer of employment I may receive is conditional on my undergoing and passing a screen for illegal drugs and alcohol, and that if I receive a conditional offer I must cooperate fully with any such test and approve the disclosure of results to DAI.

I understand that any offer of employment I may receive requires that I agree to and execute and abide by a confidentiality and intellectual property agreement in which I agree: (1) to maintain the confidentiality of propriety information and protect trademarks and service marks belonging to Daikin during my employment with DAI, as well as after such relationship ends, whether voluntarily or involuntary; and (2) that any designs, processes, formulas, compounds, inventions or other intellectual property covered by the intellectual property laws and regulations of the United States, Japan, and other pertinent locations which I develop within the scope of my employment with DAI are the exclusive property of Daikin.

I have told the whole truth on this application. I certify that the answers and information provided on this application are accurate and true and understand that DAI will discipline me up to and including immediate discharge, if DAI determines there has been any falsification, misrepresentation, or nondisclosure of information on this application.

I understand this application will remain active for 12 months, and that I must reapply if I do not receive a decision within that time.
Signature*
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Name	Location	Grade/Degree

Name	Location	Grade/Degree

Name	Location	Grade/Degree

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PERSONAL INFORMATION

GENERAL INFORMATION

EDUCATION INFORMATION

EMPLOYMENT HISTORY

READ CAREFULLY BEFORE SIGNING