Employment Application Form

We consider applicants for all positions on the basis of qualifications and without regard to race, religion, gender, national origin, age, marital status, disability, sexual orientation, use of lawful products during non-work hours and any other legally protected status.

Position(s) Applied For

First Name

Middle Name

Last Name

Street Address

Apt#

City

State

Zip

Home Phone

Mobile Phone

Alt Phone

Email Address

How did you hear about Sutherland Plumbing?

Friend

Recruiting Firm

Employee

Other

Are you available?

Full Time

Part Time

Temporary

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No

Have you ever submitted an application with Sutherland Plumbing before? Yes No

If yes, please give the dates

Have you ever been employed with Sutherland Plumbing? Yes No

If yes, please give the dates

Are you currently employed? Yes No

May we contact your current employer? Yes No

Are you legally qualified to work in the United States? Yes No
(Proof of citizenship or immigration status will be required upon employment.)

What date would you be available for work?

List any current, valid licenses or certifications you have applicable to this position

Education Background

High School Name and Location

High School Attended From / To

High School Type of Degree

High School Major and Minor Fields of Study

University Name and Location

University Attended From / To

University Type of Degree

University Major and Minor Fields of Study

College Name and Location

College Attended From / To

College Type of Degree

College Major and Minor Fields of Study

Tech School Name and Location

Tech School Attended From / To

Tech School Type of Degree

Tech School Major and Minor Fields of Study

Military Experience

Branch of Service

Years of Service

Other Skills

Languages You Speak

Hobbies

Employment Background

Employer Name

Starting Date

Ending Date

Work Performed

Full Address

Phone Numbers

Start Salary

Ending Salary

Supervisor and Title

Commission/Bonus

Reason for Leaving

Employer Name

Starting Date

Ending Date

Work Performed

Full Address

Phone Numbers

Start Salary

Ending Salary

Supervisor and Title

Commission/Bonus

Reason for Leaving

Employer Name

Starting Date

Ending Date

Work Performed

Full Address

Phone Numbers

Start Salary

Ending Salary

Supervisor and Title

Commission/Bonus

Reason for Leaving

References

Please provide at least two professional and one personal reference(s) please include: name, reference phone and email, relationship and years known.

Professional Reference

Personal Reference

Certification

I certify that the answers given herein are true and complete to the best of my knowledge. I also authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Sutherland Plumbing, LLC is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” nature, employment relationship may not be changed by a written documentation or by conduct unless such change is specifically acknowledged in writing by an authorized executive of Sutherland Plumbing, LLC.

I understand that if offered a position with Sutherland Plumbing, LLC, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to Sutherland Plumbing, LLC and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Sutherland Plumbing, LLC.

Signature Name of Applicant

Clear and Cancel Form