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Pre-employment questionnaire, Nevada County Plumbing, Inc. is a equal opportunity employer.
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| First Name: |
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Last Name: |
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| Address: |
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| City: |
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State: |
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Phone: |
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| E-mail: |
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| Desired Position: |
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(OPTIONAL) Attach resume:
ACCEPTABLE FORMATS: .doc, .wpd, .txt, .pdf
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Employment History
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Please list chronologically, beginning with most recent experience.
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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| Employer: |
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Address/City: |
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| From (MM/YYYY): |
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To (MM/YYYY): |
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Phone: |
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| Salary: |
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| Type of Work: |
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| Reason for Leaving: |
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Education
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Personal Information
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Are you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of work authorization.) |
Yes No |
| Are you at least 18 years of age?: |
Yes No |
| Briefly describe skills you may have that you acquired in other employment or armed forces: |
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| Have you ever been convicted of a crime (felony)?: |
Yes No |
If yes, give details:
(Convictions are not automatic bar to employment) |
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| If you are experienced operator of any outdoor or heavy equipment, please list: |
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| Do you have any physical limitations? If yes, please explain: |
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| Do you have any other skills you wish to mention?: |
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| Are you presently employed?: |
Yes No |
| If so, may we contact your present employer?: |
Yes No |
| If hired, when would you be available?: |
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Employment References
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| List individuals familiar with your job qualifications (No relatives or personal friends). |
| 1) Name of Reference: |
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2) Name of Reference: |
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| Occupation: |
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Occupation: |
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| Address: |
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Address: |
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| City/State/Zip: |
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City/State/Zip: |
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| Phone: |
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Phone: |
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| Relationship: |
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Relationship: |
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| How long known: |
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How long known: |
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| How Were You Referred To This Job: |
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Please read carefully before submitting your application
I certifiy that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, may application may be rejected and, if I am employed, my employment may be terminated at any time.
In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with our without cause, and with or without my notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with our without cause and with our without notice, at any time by the company. I understand that no company representative, other than its store manager, and then only when in writing and signed by the store manager, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
Check this box to certify that you have read and accept the above statement.
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