Employment Application

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Personal Data

Full Name
Email
Address
City
State
Zip Code
SSN
Cell or Home Phone
Are you eligible to work in the U.S.?
Have you ever been convicted of or pled guilty or no contest to a felony or misdemeanor?
*a yes answer will not necessarily bar you from employment. Please explain.
Have you previously worked for us?
How did you hear about us?
Have you applied here before?
If yes, When?

Position of Interest

Postion applying for?
Hours available
Days/Hours Available
Wage Expectations
Available for Overtime?
Is there any reason why you would be unable to perform the essential functions of this position without special accommodations? (ONLY answer if you have been provided with a copy of the job description and read what the essential functions are.)

Education - Highest Level of Education Completed


High School - If you did not graduate, please fill in the last school you attended.
School Name
City
State
Major Course of Study
Degree or Certification Earned
College
School Name
City
State
Major Course of Study
Degree or Certification Earned
Trade School
School Name
City
State
Major Course of Study
Degree or Certification Earned
Other
School Name
City
State
Major Course of Study
Degree or Certification Earned
May we contact your current employer prior to any potential employment offer?

Employment History

Employment History #1
Company
Phone Number
Your Title
Street Address
City
State
Zip Code
Supervisors Name and Title
Start Date Format: month/day/year
End Date Format: month/day/year
Reason for Leaving
Ending Salary
Employment History #2
Company
Phone Number
Your Title
Street Address
City
State
Zip Code
Supervisors Name and Title
Start Date Format: month/day/year
End Date Format: month/day/year
Reason for Leaving
Ending Salary
Employment History #3
Company
Phone Number
Your Title
Street Address
City
State
Zip Code
Supervisors Name and Title
Start Date Format: month/day/year
End Date Format: month/day/year
Reason for Leaving
Ending Salary
Employment History #4
Company
Phone Number
Your Title
Street Address
City
State
Zip Code
Supervisors Name and Title
Start Date Format: month/day/year
End Date Format: month/day/year
Reason for Leaving
Ending Salary
Employment History #5
Company
Phone Number
Your Title
Street Address
City
State
Zip Code
Supervisors Name and Title
Start Date Format: month/day/year
End Date Format: month/day/year
Reason for Leaving
Ending Salary
Please list additional experience or skills that have a direct relationship to the job for which you are applying, including any licenses, and their latest dates of origination and issuing authority.
Have you ever had a professional or vocational license or certificate(if any) denied, revoked, or suspended?

License or Certificate

License or Certificate
Expiration Date Format: month/day/year
Issuing Authority
City
State
License or Certificate
Expiration Date Format: month/day/year
Issuing Authority
City
State
License or Certificate
Expiration Date Format: month/day/year
Issuing Authority
City
State

Professional Reference - Please list references who are not related to you or are previous supervisors

Name
Company
Phone Number
Years Known
Name
Company
Phone Number
Years Known
Name
Company
Phone Number
Years Known

Applicant’s Certification and Acknowledgment

Please read this carefully before signing below.

Background Check Disclosure

I hereby certify that the information I have provided in this application and in any documents I have submitted to Neu Plumbing in support of my application for employment, including resumes and transcripts, and/or information provided during the interview process, is complete and accurate to the best of my knowledge. I realize any falsification and/or misrepresentation or material omission of that information, stated or implied, may result in the denial of any employment offer, or the immediate termination of my employment if I am employed.


I also understand that employment with Neu Plumbing is conditioned upon the completion of an Authorization for Release of Background Information and other employment documents as necessary, as determined by the company. In conjunction with the requirements of the federal Fair Credit Reporting Act and/or other applicable law, I hereby authorize and consent to the investigation of all statements contained in this application and authorize all persons and companies named above and/or their agents to release any and all records and information pertaining to my employment history, police record, education background, military service, or personal reputation. Pursuant to applicable law I hereby release all parties from liability for damage for providing this information.


I understand that my employment with Neu Plumbing is “at will.” If I become employed by Neu Plumbing my employment and compensation are for no definite period and, regardless of the time and manner of payment of my wages, salary or other benefits, my employment and compensation can be terminated at any time, with or without cause and with or without notice at either the option of the Company or myself. I further understand that there are no other arrangements, agreements or understandings, oral or written, contrary to the foregoing and that the understanding set out herein supersedes any prior contrary statements. I further understand that any modification to this Certification and Acknowledgment will not be effective unless in writing and personally signed by a representative of the company having actual authority to approve such modification.


I understand that, if I am hired, I am required to abide by all of the Company’s rules, policies and procedures. I also understand that the Company’s rules, policies and procedures can and may be changed or modified at any time, with or without notice.


Signature