Job Application

Employment Application

Our company is an equal opportunity employer and adheres to the principles and practices outlined in the Civil Rights Act of 1964, which prohibits discriminiation in employment on the basis of race, sex, religion, or national origin and Public Law 90-202 which prohibits discriminiation based on age.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner, as no action can be taken on this application until all questions have been answered.

First Name:
Middle Name:
Last Name:
Present Street Address:
City:
ST:
Zip Code:
Social Security #:
	Are you over the age of 18?
Have you ever been convicted of any crime? (Not including a traffic violation, but including DUI/DWI? If yes, state the offense, location, date, and disposition:
EMERGENCY CONTACT
Name:
Relationship:
Address / City / ST / Zip:
Telephone #:
Drivers License #:
Licensed In The State of:
Type/Case of License:
Employment Desired (are you seeking):	Full Time
	Part-Time
	Temporary/Summer Employment
Position Applying For:
Desired Salary:
Available Start Date:
Have you ever applied to our company before? (yes or no):
Have you ever worked for our company before? (yes or no):
If your answer to either of the above questions is Yes, state when and where you applied and/or worked:
How did you learn about our company and/or position?:
Are you now or do you expect to be engaged in any other business or employment? (yes or no):
Are there any days or hours you would be unable or unwilling to work? (yes or no):
If yes above, please specify:
EDUCATION:
High School:
Date (From - To):
	Yes, I graduated.
College:
Date (From - To):
	Yes, I graduated.
Trade School:
Dates (From - To):
	Yes, I graduated.
If you did not graduate, explain why (high school / college):
Are you planning to pursue further studies? (yes or no):
If so, (when, where, and what courses):
List any scholastic honors, offices held and activities involved in during high school and college:
List and describe any other School or Specialized Training:

MILITARY
Have you ever served in the military? (yes or no):
Service Branch:
Date Entered:
Date Separated:
Final Rank:
Where you seperated from service with any degree of disability?: If so, what degree?
Are you a member of a reserve organization? (yes or no):
HEALTH:
Do you have any physical defect or illness that may limit your ability to perform the particular job for which you are applying? (yes or no):
If yes, please describe:
Date of last physical exam::
Results:
Have you ever been injured on the job? (yes or no):
If yes, please describe: (below)
(1) Nature of Injury:
Employer:
Year:
Cause:
(2) Nature of Injury:
Employer:
Date:
Cause:
Will you abide by the safety rules of this company? (yes or no):
Are you willing to take a physical exam and a urinary drug screening at company expense? (yes or no):
Have you ever received treatment for alcohol or drug use? (yes or no):
Have you used any illegal drug, including marijuana, in the past twelve months? (yes or no):
Days lost in the last two years due to illness?:
Reason:
OTHER INFORMATION:
What experience do you have in service plumbing?:
Days lost in the last two years due to illness?:
How long have you been in service work?:
With the right incentives, would you consider making this your career?:
What equipment and tools are you proficient with?:
Service plumbers work irregular hours. How do you feel about working nights? Weekends? and Holidays?:
Would you be an asset to our company?:
Are you willing to receive additional training for career advancement?:
Have you ever been rewarded for high sales, best attendance or any other type of recognition?:
If I met your formal boss at a social function, and asked to hear just one sentence about you, what would that sentence be?:
If we reversed it, what would your sentence be about your boss?:
What do you like the most about service plumbing?:
What do you like the least about service plumbing?:
Tell me about your family:
Using adjectives, describe your mother:
Outside of work, what activities do you need time for?:
Do you read any trade magazines? (list):
Describe to me the perfect plumbing company that you would like to work for::
Are you willing to take random drug tests? (yes or no):
Will you be available for a personal interview? (yes or no):
Would you consider yourself to be a motivated person?:
Would you consider yourself well groomed, describe::
Below list two personal references with phone numbers, also list one person that you have worked with::
Rate yourself (1-5 with 1 being the lowest and 5 being the highest):
Communications Skills:
Integrity:
Intelligence:
Technical Ability:
Positive Attitude: