Orlando Area Plumbers

General Information

Name

Date

Address

City/State/Zip

Phone Number

Alternate Phone Number

Previous Address if less than 5 years at the current address (City, State)

Email

If hired, can you provide verification of your legal right to work in the United States?
 Yes No

Are you at least 18 years of age?
 Yes No

Have you been terminated or asked to resign? If yes, provide details.
 Yes No

Conviction record may not necessarily prohibit employment. Factors such as date, nature and offense will be considered.

Have you pled guilty or \"no contest\" to a crime, been convicted of a crime, had adjudication withheld or prosecution deferred? If yes, please give date and details.
 Yes No

Have you been a defendant in a suit such as assault, battery, false imprisonment, wrongful death? If yes, please give date and details.  Yes No

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Position

Position Applying For:

Minimum pay rate $

Date available to start:

How did you learn about our company and/or position?
If employee referral, provide name:

Are there days or hours you would be unable to work?
 Yes No

If yes, when?

Will you be able to work overtime?
 Yes No

Will you be able to travel within Florida?
 Yes No

Have you applied with our company before?
 Yes No

When?

Have you been employed by Modern Plumbing Industries?
 Yes No

When?

Reason for Leaving?

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Education

High School

High School Name

City/State

Graduated:  Yes No

GED:  Yes No

College

College Name

City/State

Years complete: 01234

Graduate School

College Name

City/State

Years Complete 01234

Are you planning on Continuing Education?  Yes No

If yes, when, where and what courses?

List any educational honors and activities
involved in during school:

List and describe specialized training:

Professional License:

Certification:

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Driving

Some positions require reporting to different job sites. Reliable transportation is necessary.

Will you be able to report on a regular consistent basis?
 Yes No

If no, explain:

Do you have a valid driver\'s license issued in Florida?
 Yes No

Any history of license restrictions?
 Yes No

If yes, explain:

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Safety

List Safety Training:

Will you abide by our safety rules?
 Yes No

Have you been disciplined for violating safety rules?
 Yes No

If yes, explain:

Skills

Check the programs you are skilled in:
 Word Excel Access Outlook

List other programs:

What skills qualify you for a position?

Professional / Industry References

List three references. Do not use relatives.

1

Name:

City:

Phone:

Occupation:

2

Name:

City:

Phone:

Occupation:

3

Name:

City:

Phone:

Occupation:

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Employment (start with current or most recent employer)

Employer 1.

Employer:

Position:

City, State:

Telephone:

Supervisor\'s Name:

Salary

Starting:

Ending:

Dates:

From: (mo/yr)

To: (mo/yr)

Duties:

What did you like most about your job?

What did you like least about your job?

Reason for leaving:

Eligible for Re-hire?  Yes No

Employer 2.

Employer:

Position:

City/State:

Telephone:

Supervisor\'s Name:

Salary

Starting:

Ending:

Dates:

From: (mo/yr)

To: (mo/yr)

Duties:

What did you like most about your job?

What did you like least about your job?

Reason for leaving:

Eligible for Re-hire?  Yes No

Employer 3.

Employer:

Position:

City/State:

Telephone:

Supervisor\'s Name:

Salary

Starting:

Ending:

Dates:

From: (mo/yr)

To: (mo/yr)

Duties:

What did you like most about your job?

What did you like least about your job?

Reason for leaving:

Eligible for Re-hire?  Yes No

Supplemental Employment Information

If you worked using another name, please list name(s) here:

Name:

at (company)

Name:

at (company)

Are you currently employed?  Yes No

If yes, may we contact your present employer?  Yes No

Have you been disciplined, warned, demoted, suspended, placed
on probation or terminated?
 Yes No

If yes, explain:

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Applicant\'s Statement

I understand that if my application is considered for employment, I authorize a verification of all statements and information. In connection with my application, I understand that results of the background inquiries and personal information may be released to Modern Plumbing Industries. I also release any and all persons, companies, or agencies responding to such investigation from any liability for damage due to releasing information.

I certify that answers given are true and complete to the best of my knowledge. I further understand that misrepresentation of facts on this application or interview is cause for rejection of this application or for subsequent dismissal from employment no matter when discovered.

In consideration of employment, I agree to comply with the rules and regulations of Modern Plumbing Industries and my employment can be terminated for any reason and without notice, at any time, at the option of either the Company or myself. I further understand that no oral promise, policy, business practice or other procedure, including any handbooks or manuals, constitutes an employment contract or modification of the at-will employment relationship between myself and Modern Plumbing Industries.

I understand that no supervisor or other official of Modern Plumbing Industries (except its President) has the authority to enter into an agreement with me or to make any agreement contrary to foregoing.

Applications (via internet, email, fax, mail, or submitted in person) remain active for sixty (60) days.

I understand MPI reserves the right to request pre-employment, post accident, random or reasonable suspicion drug screening.

DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THE APPLICANT\'S STATEMENT.

Digital Signature:

Date:

By typing your name in the signature box above, you are signing this document and stating that you read and understand the Applicant\'s Statement.

Paste Resume Here:

Or Upload Resume:

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