Simple Job Application Form

Job Application

Please complete the form below to apply for a position with us.
Full Name *

First Name Middle Name Last Name

Current Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email Address *
Phone Number *

Area Code Phone Number
Applying for Position *
Hours Wanted *
Start date

Month Day Year Date Picker Icon
Can You Work

Saturdays Evenings
Upload Resume *
Have you previously been employed by our organization? *

Yes No

Employment History #1

List below the last three employers, starting with the most recent one first.
Position *
Name Of Company *

Company Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Start Date

Month Day Year
Date Date Picker Icon
Major Duties
Can we Contact the supervisor?

Yes No
Final Wage

Employment History #2

List below the last three employers, starting with the most recent one first.
Position *
Name Of Company *

Company Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Start Date

Month Day Year
Date Date Picker Icon
Major Duties
Can we Contact the supervisor?

Yes No
Final Wage

Employment History #3

List below the last three employers, starting with the most recent one first.
Position *
Name Of Company *

Company Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Start Date

Month Day Year
Date Date Picker Icon
Major Duties
Can we Contact the supervisor?

Yes No
Final Wage

Education Information
High School or GED
School Name *

School Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Degree *
College
School Name *

School Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Degree *
College
School Name *

School Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Degree *
Other
School Name *

School Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Degree *
Special Skills/Training/Certifications/Organizations

(Please do not list activities that would indicate age, sex, color, race, creed, national origin, religion, marital status, secual orientation, political belief or disability.)
Have you ever been convicted of a crime other than a minor misdemeanor or traffic offense?

Yes No
Where and what is the nature of the offense?

References
Reference #1
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Reference #2
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Reference #3
Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Please read the following statements carefully.

In consideration of my employment, I agree to conform to the policies and procedures of Lee Plumbing Mechanical Contractors. I understand that in accepting this application, the company is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without cause, and with or without notice at any time.

I certify that the facts contained in this application are true and complete to the best of m knowledge. I understand that any falsified statements on this application or omission of fact on either this application or during the pre-employment process will result in my application being rejected, or, if I am hire, in my employment being terminated.

I also understand that any offer of employment is conditioned on the completion of pre-employment tests and documentation.
Date *

Month Day Year
Date Date Picker Icon
Signature *

Clear
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