Employment Application Form

Name:		Phone:
Address:		City:
State:		Zip:

Are you over 18?
Yes No
Are you applying for a position that requires a driver's license?
Yes No
Are you a citizen of the U.S. or do you have a legal right to be employed in the United States?
Yes No
Have you ever been convicted of any crime (excluding minor traffic violations) including DWI
Yes No
If yes, please provide your Drivers Lic. Number & State:

Employment Desired
Position applied for:
Plumber or Apprentice license number & expiration?
Year first licensed:
Has your professional license ever been suspended or revoked? (if yes, explain)
How did you learn of our company and/or position?
Work History
List below all present and past employment, beginning with your most recent.
Name of Employer	Supervisor	Date Employed
Address		from
City, State, Zip	Reason for Leaving	to
Phone
Position


Name of Employer	Supervisor	Date Employed
Address		from
City, State, Zip	Reason for Leaving	to
Phone
Position

Affidavit
I certify that the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that you shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. I also authorize the companies, schools or persons named above to give any information regarding my employment, character and qualifications and hereby release said companies, schools or persons from all liability for any damage for issuing this information. I further understand that the taking of drug tests, background and driving record checks may be a condition of employment and refusal to take such tests or agree to such investigative reports when required, will subject me to the termination or non-employment. I also understand that no person is authorized to enter into any written or verbal employment contract on behalf or Paul Flaherty Plumbing & Heating Co., Inc. without the express written consent of the president. I understand my employment is at will. Check here to confirm you've read and agree with the terms of the application

Toll Free: (800) 585-1775

Employment Application Form

Have you ever been convicted of any crime (excluding minor traffic violations) including DWI

Employment Desired

Work History

Affidavit

Have you ever been convicted of any crime
(excluding minor traffic violations) including DWI