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Date *

Name *

Street Address *

City *

State

ZIP Code

Phone *

Email *

Best Way to Contact You *

Call

Email

Text

Date Available *

Current Salary *

Desired Salary *

Position Applying For *

Are you a citizen of the United States? *

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company? *

Yes

No

If so, when?

Are you willing to work overtime, including weekends? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

If yes, please explain

How did you hear about the employment opportunity?

High School *

Address *

From - To *

Did you graduate? *

Yes

No

Degree *

College

Address

From - To

Did you graduate?

Yes

No

Degree

Other Education

Address

From - To

Did you graduate?

Yes

No

Degree

Other qualifications such as special skills, abilities or honors that should be considered:

Professional licenses, certifications or registrations:

Current Licenses and Certifications – please include issue and expiration dates:

Reference 1: Full Name *

Reference 1: Relationship *

Reference 1: Company *

Reference 1: Phone *

Reference 1: Address *

Reference 2: Full Name

Reference 2: Relationship

Reference 2: Company

Reference 2: Phone

Reference 2: Address

Reference 3: Full Name

Reference 3: Relationship

Reference 3: Company

Reference 3: Phone

Reference 3: Address

Reference 1: Full Name

Reference 1: Relationship

Reference 1: Phone

Reference 1: Address

Reference 1: Email

Reference 2: Full Name

Reference 2: Relationship

Reference 2: Phone

Reference 2: Address

Reference 2: Email

Reference 3: Full Name

Reference 3: Relationship

Reference 3: Phone

Reference 3: Address

Reference 3: Email

Checking this box gives permission to contact personal references.

I agree

Company *

Phone *

Address *

Supervisor *

Job Title *

Starting Salary *

Ending Salary *

Responsibilities *

Skills *

Start Date - End Date *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

Yes

No

Add another company? *

Yes

No

Disclaimer *

I understand and agree to the information shown above.

I certify that my answers are true and complete to the best of my knowledge. As part of our procedure for processing your employment application, your professional references and employment may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or drug test, or to sign a non-compete and/or non-disclosure agreement and abide by its terms.

Digital Signature *

Date *

Careers at Simpson Plumbing: Application Form

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