Application - Chris' Plumbing

Date

Personal

Full Name (First + Middle + Last)*

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone*

Email Address*

How did you hear about our company?

Employment Information

Date of Birth

Do you have the legal right to live and work in the U.S.?*

Yes
No

Social Security Number

Citizenship/Work Status*

Other name(s) under which you have been previously employed

Current Employer (if applicable)

What Position are you applying for?

Years of Work Experience directly related to the position you are applying for*

Employment Type Desired:*

Full-Time
Part-Time

Desired Compensation*

Please note Hourly or Annual

Other Compensation Desired:

When are you available to start work?*

Education

Where did you attend high school & college/trade school?*

(Click the + button to add a new row)

Type of School	Name of School	Location	# of Years Completed	Major & Degree

Are you taking any educational course(s) presently?*

Yes
No
I will be soon

If Yes or you will be soon, what and where?

Criminal History

Have you ever been convicted of a felony or misdemeanor (except any minor traffic violations)?*

No
Yes

If yes, please explain and attach any relevant documentation below. Be sure to list dates, offenses, and disposition.

Convictions are not an automatic disqualification from employment.

File

Driver's License Information

Do you have a valid Driver's License?*

Yes
No

Do you have reliable transportation to work (please be specific)?

Driver's License Number

Driver's License State of Issue

Driver's License Type

Operator
Commercial (CDL)
Chauffeur

Do you have a clean driving record?*

Yes
No

List any Moving Violations and/or Accidents from the last 3 years:

Military Service

Have you ever served in the U.S. Armed Services?*

Yes
No

Branch:

Are you currently a member of the National Guard or Reserves

Yes
No

Specialty

Date Entered

Discharge Date

Work Experience

Please list your work experience for the past 5 years, beginning with your MOST RECENT job. If you were self-employed, give firm name. There is also a place at the end to upload your resume, if applicable.

Name of Employer (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor's Name & Title

Dates Employed

From	To

Base Rate of Pay (Hour/Week/Month)

Start	End

Job Title

Reason for Leaving?

Description of duties

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Name of Employer (Second Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor's Name & Title

Dates Employed

From	To

Base Rate of Pay (Hour/Week/Month)

Start	End

Job Title

Reason for Leaving?

Description of duties

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Would you like to list another previous job?

Yes
No

Name of Employer (Third Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor's Name & Title

Dates Employed

From	To

Base Rate of Pay (Hour/Week/Month)

Start	End

Job Title

Reason for Leaving?

Description of duties

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Would you like to list a 4th job?

Yes
No

Name of Employer (Fourth Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor's Name & Title

Dates Employed

From	To

Base Rate of Pay (Hour/Week/Month)

Start	End

Job Title

Reason for Leaving?

Description of duties

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact this employer?

Yes
No

Plumbing Industry Skills

ONLY select the specific industry skills that you consider yourself to be VERY knowledgeable about, with a HIGH level of competency.

What types of systems have you worked with?

(Select all that apply)

What types of pipe and lines have you worked with?

(Select all that apply)

What Applications do you have experience with?

(Select all that apply)

What specific parts, pumps, valves, fittings, etc. have you worked with?

(Select all that apply)

What Job Functions have you performed?

(Select all that apply)

What Computer related experience do you have?

(Select all that apply)

Certifications & Licenses

What Certifications & Licenses do you have?

(Select all that apply)

Include State and License Numbers for any licenses selected above, if applicable:

Other Licenses & Certifications held:

Additional Information

Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. If you have a resume, please upload it at the end of this application.

Professional References

List 3-4 people you have worked with who can attest to your on-the-job experience and performance. Do not include relatives. (Click the + button to add a new row)*

Name	Position	Company	Telephone	Email Address

Did you complete this application yourself?*

Yes
No

If not, who did?

Agreement (please read carefully before signing)

I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that any misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment.

I understand that neither the acceptance of this application, nor the subsequent entry into any type of employment relationship with Chris' Plumbing & Repair, INC., creates an actual or implied contract of employment. I understand that, if I accept employment with Chris' Plumbing & Repair, INC., it will be on an at-will basis. This means that either Chris' Plumbing & Repair, INC. or I have the right to terminate the employment relationship at any time, for any reason, with or without cause.

I agree to submit to alcohol testing, if requested by Chris' Plumbing & Repair, INC. I release Chris' Plumbing & Repair, INC. and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.

I authorize Chris' Plumbing & Repair, INC. to investigate information concerning my education, licensing, certifications, driving record, criminal history, employment experiences and all other aspects of my background relevant to my proposed employment. I release Chris' Plumbing & Repair, INC. and its employees from all liability arising from such investigation.

*Chris' Plumbing & Repair, INC. is an equal opportunity employer. We adhere to a policy of making decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Chris' Plumbing & Repair, INC. depends solely on your qualifications.

Digital Signature:

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

Resume Upload (optional)

If you have a resume you'd like to attach, please do so here. This is not required.

Would you like to add a cover letter?

Yes
No

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.