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° Indicates Required Fields

Contact Information

° Full Name

° Street Address

Apartment/Unit/Lot

° City

° State

° Zip Code

° Primary Phone `

Phone 2 `

E-mail

Preferred Method
of Contact
Select all that apply E-mail
Mobile Phone
Home Phone
Mail

Applicant Information

Date Available

Desired Salary

° Desired Position

Are you a citizen of the United States? yes no

If no, are you authorized to work in the U.S.? yes no

Have you ever worked for this company? yes no

If yes, when?

Have you ever been convicted of a felony? yes no

If yes, explain

Education

High School

Name of High School

School Address

Dates Attended

Did you graduate? yes no

College

Name of College

College Address

Dates Attended

Did you graduate? yes no

Degree

Other School

Name of School

School Address

Dates Attended

Did you graduate? yes no

Degree

References

Please list three professional references.

Reference 1

Full Name

Relationship

Company

Phone

Street Address

Reference 2

Full Name

Relationship

Company

Phone

Street Address

Reference 3

Full Name

Relationship

Company

Phone

Street Address

Previous Employment

Most Recent Job

Company

Phone

Street Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Dates employed

Reason for leaving

May we contact your supervisor for a reference? yes no

Military Service

Branch

Dates of Service

Rank at Discharge

Type of Discharge

If other than honorable discharge

Questions for Potential Residential Workers

Do you have a current valid Michigan driver's license? yes no

Are there any restrictions to your driver's license?

Do you have other endorsements to your driver's license, such as Chauffeur or CDL?

Do you have reliable transportation to get you to and from work on a daily basis? yes no

Are you currently working in the plumbing/residential industry? yes no

Why are you interested in the plumbing/housing industry?

What is your previous experience in the plumbing/housing industry?

Where do you see yourself in 2 years – Personally? Occupationally?

Do you have any residential/service work experience? yes no

Do you have any knowledge of Hydronic Heating? yes no

Do you have a State of Michigan Journey or Master Plumbers License? yes no

Plumbers License Number

If no, are you registered as an apprentice? yes no

with the Michigan Department of Labor & Economic Growth Bureau of Construction Codes

Have you had any formal training with the Michigan State Plumbing Codes? yes no

Do you have any manufacturers certifications, such as PEX water piping or corrugated stainless steel gas piping?

Do you have any reasons why
you would not be able to work
during the hours of 6:00 am – 4:30 pm,
Mon. – Fri. (5 days a week)?

Do you have your own hand tools? yes no

If no, would you be willing to provide your own hand tools? yes no

Disclaimer / Submit

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Send a copy of this application to the E-mail entered above.


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