Date
Applicant's Name (First Middle Last)
Address
Home Phone Cell Phone
Driver's License # State Expiration
*These questions are for auto insurance purposes if you become a driver for the company.
Is your current driver's license valid? Yes No Date / Circumstance (if Yes)
Has your driver's license been revoked or suspended in the last 5 years? Yes No Date / Circumstance (if Yes)
Have you been charged with reckless driving, speeding, red light/stop sign, or other moving violations in the past 5 years? Yes No Date / Circumstance (if Yes)
Have you been charged with a DUI or DWI in the past 5 years? Yes No Date / Circumstance (if Yes)
Have you been involved in an auto accident in the past 5 years? Yes No Date / Circumstance (if Yes)
High School Completed Select... 9 10 11 12 GED
College
Skilled Training
Do you currently have a Plumbing card? Yes No
State Issued Expiration
Card Type Select... Apprentice Plumber Journeyman Plumber Master Plumber Journeyman Gas Fitter Master Gas Fitter
Company Name
Contact Phone
Dates of Service Reason for Leaving
Can Premier Plumbing contact your former employers for a reference? Yes No If no, please explain
Will you be willing to take the mandatory, random drug test? Yes No
Have you ever been convicted of a felony? Yes No If yes, please explain
Have you ever been arrested or charged with a drug-related offense? Yes No If yes, please explain
Is there any reason that you could not be at work each day, on time, for the full period of work? Yes No If yes, please explain
Describe any experience that qualifies you for this job.
Provide any references (if different than your past 3 employers) who can verify your ability to do the job.
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation may result in disqualification from employment or termination.
Full Name (serves as your signature) Date
Submit Application
