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1
Information
2
Education
3
Skills & Qualifications
4
References - Professional
5
References - Personal
6
Previous Employment
7
Last Page
Last Name *
First *
M.I. *
Date *
Street Address *
Apt/Unit *
City *
State
ZIP Code
Phone *
Email *
Date Available *
Desired Salary *
Position Applying For *
Are you a citizen of the United States? *
If no, are you authorized to work in the U.S.?
Have you ever worked for this company? *
If so, when?
Are you willing to work overtime, including weekends? *
How did you hear about the employment opportunity?
High School or GED *
Address *
From *
To *
Graduated? *
Degree *

College or Trade School:
Address
From
To
Graduated?
Degree

Other/Trade School:
Address
From
To
Graduated?
Degree/Certificate:
List relevant skills, abilities, honors, or certifications:
Professional Licenses / Certifications:
Issue Date *
Expiration Date *
Professional Licenses / Certifications:
Issue Date *
Expiration Date *
Professional Licenses / Certifications:
Issue Date *
Expiration Date *
Professional licenses/certifications:
Issue Date *
Expiration Date *

List three professional references (Name, Relationship, Company, Phone, Address)

Professional Reference 1: Name
Professional Reference 1: Address
Professional Reference 1: Phone
Professional Reference 1: Email
Professional Reference 1: Relation

Professional Reference 2: Name
Professional Reference 2: Address
Professional Reference 2: Phone
Professional Reference 2: Email
Professional Reference 2: Relation

Professional Reference 3: Name
Professional Reference 3: Address
Professional Reference 3: Phone
Professional Reference 3: Email
Professional Reference 3: Relation

List three personal references (not relatives). Include Name, Relationship, Address, Phone, Email

Personal Reference 1: Name
Personal Reference 1: Address
Personal Reference 1: Phone
Personal Reference 1: Email
Personal Reference 1: Relation

Personal Reference 2: Name
Personal Reference 2: Address
Personal Reference 2: Phone
Personal Reference 2: Email
Personal Reference 2: Relation

Personal Reference 3: Name
Personal Reference 3: Address
Personal Reference 3: Phone
Personal Reference 3: Email
Personal Reference 3: Relation
Company *
Phone *
Address *
Supervisor *
Job Title *
Ending Salary (optional)
Responsibilities / Duties *
Start Date
End Date
Reason for Leaving *
May we contact your previous supervisor ? *
Add another company? *

Company
Phone
Address
Supervisor
Job Title
Ending Salary (optional)
Responsibilities / Duties
Start Date
End Date
Reason for Leaving
May we contact your previous supervisor ?
Add another company?

Company
Phone
Address
Supervisor
Job Title
Ending Salary (optional)
Responsibilities / Duties
Start Date
End Date
Reason for Leaving
May we contact your previous supervisor?
Add another company?

Company
Phone
Address
Supervisor
Job Title
Ending Salary (optional)
Responsibilities / Duties
Start Date
End Date
Reason for Leaving
May we contact your previous supervisor for a reference?
Add another company?

Company
Phone
Address
Supervisor
Job Title
Ending Salary (optional)
Responsibilities / Duties
Start Date
End Date
Reason for Leaving
May we contact your previous supervisor for a reference?
Current Employer
DISCLAIMER AND SIGNATURE *
I authorize Simpson Plumbing, LLC to verify employment and reference information provided, subject to my consent regarding current employer contact.
If necessary for employment, I may be required to provide proof of authorization to work in the U.S. and/or undergo job-related testing consistent with Washington law.
Simpson Plumbing, LLC is an Equal Opportunity Employer. We do not discriminate on any protected basis under federal or Washington law.
Applicants are entitled to request the wage scale or salary range for any posted position and a general description of benefits.
This application will be used solely for employment purposes and will be kept confidential as required by law.
Signature *
Date *
Plumbing Company
Simpson Plumbing was created and founded by Dale Simpson’s passion and commitment to providing quality plumbing work in Vancouver and Camas areas.
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