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Application for Employment

Federal law prohibits discrimination on the basis of race, color, religion, sex,

national origin, age, disability or other protected status.

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Personal Data

Personal Data

Position Applying For:

Date:

Name:

Address:

Phone Number:

Mobile Number:

Social Security Number:

D.O.B:

Drivers License Number:

State Issued In:

Expiration Date:

How Did You Hear About This Job?

Salary Desired:

Can you prove you are legally eligible for work in the U.S.?

If under 18 of age can you furnish a work permit if required?

If not, please explain:

If hired, are you able to get to work and meet attendance requirements everyday?

Have you been convicted of a felony in the last five (5) years?

If Yes, please explain:

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Conviction does not automatically bar you from employment consideration.

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Type of employment wanted:

Date of Available to begin work:

What hours do you prefer to work?

Can you work overtime, if required?

Weekends, if required?

Please list hours you cannot work:

Can you work overtime, if required?

Please Explain:

How many days have you been late in the last year:

Please Explain:

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Education Background

Please select the highest level of education attained:

Technical/Trade School (which field):

Military Education:

College Level:

Name of College

Location:

Graduate School:

Name of School:

Location:

Degree Earned / Year:

Are you currently in school:

What Level?

Summarize any special training or skills that may qualify you for the position you are applying for.:

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Employment History

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Please list your last four employers, starting with the most recent.

Employer:

Supervisor’s Name & Title:

Address:

Phone Number:

Job Title/Position:

Describe Duties:

Reason for Leaving:

Starting Date:

Ending Date:

Starting Salary/Rate:

Ending Salary/Rate:

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Employer:

Supervisor’s Name & Title:

Address:

Phone Number:

Job Title/Position:

Describe Duties:

Reason for Leaving:

Starting Date:

Ending Date:

Starting Salary/Rate:

Ending Salary/Rate:

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Employer:

Supervisor’s Name & Title:

Address:

Phone Number:

Job Title/Position:

Describe Duties:

Reason for Leaving:

Starting Date:

Ending Date:

Starting Salary/Rate:

Ending Salary/Rate:

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Employer:

Supervisor’s Name & Title:

Address:

Phone Number:

Job Title/Position:

Describe Duties:

Reason for Leaving:

Starting Date:

Ending Date:

Starting Salary/Rate:

Ending Salary/Rate:

Please explain any employment gaps found above:

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I certify that the statements contained herein are true and correct to the best of my knowledge, and I understand that any false statements or omissions by me on this application and any other required document is considered a cause for denial of employment or discharge, whenever discovered.

I understand that this document is an application for employment, and does not constitute an agreement or contract for employment of any length of time. If hired, I have the freedom to quit at any time. The employer also has the right to terminate my employment with or without cause, the exceptions required by law.

I authorize M. Cary & Daughters Plumbing Contractors, Inc. to investigate all information in the above application for employment. M. Cary & Daughters Plumbing Contractors, Inc. has the right to contact previous employers, schools and other references to verify this information. I release the employer from any liability in gathering this information. I release from liability any companies or institutions supplying this information. After termination of employment, for whatever reason, I release M. Cary & Daughters Plumbing Contractors, Inc. From any liability for any information supplied to future potential employers.

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I hereby confirm that all the information provided is true, accurate, and complete to the best of my knowledge. I acknowledge and accept the contents and conditions as stated.

Date: