Gary's Plumbing Employment-Application

Position Applied For
Salary Desired
Name
Date
Address
City, ST, Zip
Home Phone
Alternate Phone
Date of Birth
Are you a US Citizen?
How were you referred to us?
When are you available to begin work?
Have you ever been convicted of a felony? (A conviction record will not necessarily be a bar to employment)
If Yes Explain In Detail:

Educational History

High School Name
Location
Dates Attended
Graduated
If No Explain
Trade or Technical School (After High School)
Location
Dates Attended
Graduated
If No Explain

Special Skills

Equipment/ Machinery, Etc.
Other Skills &/or Experience

Employment History

Please list below the last three (3) employers beginning with the most recent.

Company Name & Address
Type of Bussines
Supervisors Name
Phone Number
Dates of Employment
Position Held
Duties

Reason For Leaving

May we contact for reference?
If No why?
Company Name & Address
Type of Bussines
Supervisors Name
Phone Number
Dates of Employment
Position Held
Duties

Reason For Leaving

May we contact for reference?
If No why?
Company Name & Address
Type of Bussines
Supervisors Name
Phone Number
Dates of Employment
Position Held
Duties

Reason For Leaving

May we contact for reference?
If No why?

Personal References

Please list two (2) persons who have knowledge of your qualifications (Past Boss, Teacher, Etc.).

Name
Relation/Title
Address
City, ST & ZIP
Contact Number(s)
Best Time To Call
Name
Relation/Title
Address
City, ST & ZIP
Contact Number(s)
Best Time To Call

Gary's Plumbing, Inc. is an equal opportunity employer, we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

Gary's Plumbing, Inc. is a Drug Free Workplace and has a drug and/or alcohol testing program in place at this time. Should you be hired, you agree to a pre-employment drug screening. If the results of that test are positive, the employment offer may be withdrawn. You agree to work under the conditions of a Drug Free Workplace and may be subject to urinalysis and/or blood screening to detect the presence of alcohol or controlled drugs.

I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company and/or myself.

This application will be held for six (6) months from the date of application. You may submit a new application at any time.

I have read, understand and agree to the above statements.

Signature
Clear
Date