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? *

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

How did you hear about the employment opportunity?

High School or GED *

Address *

From *

To *

Graduated? *

Yes

No

Degree *

College or Trade School:

Address

From

To

Graduated?

Yes

No

Degree

Other/Trade School:

Address

From

To

Graduated?

Yes

No

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

Checking this box gives permission to contact personal references

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 ? *

Yes

No

Add another company? *

Yes

No

DISCLAIMER AND SIGNATURE *

I certify that my answers are true and complete to the best of my knowledge.

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 *

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