Donn Botzum Services/Pristine Plumbing is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law.

If hired, can you provide documents required to establish your eligibility to work in the U.S.? Yes No

High School or last grade completed

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Reason for Leaving WORK RELATED REFERENCES: (Do not include relatives) NameOccupation 1.

Years Known Contact Information

STATEMENT (Please read this statement carefully before signing this application):

I understand that employment with Donn Botzum Services/Pristine Plumbing (the Organization) is at-will, meaning that I or the Organization may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I authorize the Organization to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the Organization, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand that the Organization requires the successful completion of a drug and/or alcohol test as a condition of employment. In Colorado, marijuana is exempt from drug testing.

I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.