Employment Application
Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race,
creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other
characteristic protected by law. Pipetech Plumbing and Rooter is an equal opportunity employer.
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| First Name: |
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Last Name: |
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| Address: |
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| City: |
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State: |
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| Zip: |
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Phone: |
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| E-mail: |
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| Desired Position: |
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| If Other: |
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Employment History
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Please list chronologically, beginning with most recent experience.
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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Education
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Personal Information
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Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.)
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Briefly describe skills you may have that you acquired in other employment or armed forces:
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Have you ever been convicted of a crime (felony)?:
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If yes, explain:
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Do you have any other skills you wish to mention?:
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Are you presently employed?:
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If so, may we contact your present employer?:
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| If hired, when would you be available?: |
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Employment References
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List individuals familiar with your job qualifications.
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| 1) Name of Reference: |
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2) Name of Reference: |
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| Occupation: |
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Occupation: |
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| Address: |
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Address: |
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| City/State/Zip: |
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City/State/Zip: |
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| Phone: |
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Phone: |
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| Relationship: |
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Relationship: |
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| How long known: |
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How long known: |
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How Were You Referred To This Job:
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Please read carefully before submitting your application
All information contained in this application is true and correct to the best of my knowledge and belief. I understand that
misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if
I am hired. Regardless of whether or not I become employed by the company, I recognize that this application is not and should not
be considered a contract of employment.
Check this box to certify that you have read and accept the above statement.
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