EMPLOYMENT APPLICATION

Personal Information
Name *
Name
Address *
Address
Include City, State, Zip Code
Home Phone
Home Phone
Cell Phone *
Cell Phone
Employment Information
U.S. Citizen, Green Card Holder, U.S. Work Permit/Visa, Canadian Citizen, Canadian Work Permit/Visa
(Contact Name & Contact Number)
(Full-Time or Part-Time)
$
$
Education
(Name of School, Location, High School Diploma or GED?)
(Name of School, Location, Major, Associates or Bachelor’s?)
(Name of School, Location, Major, Certificate?)
Please check all certificates/licenses you currently have in the State of Ohio:
Criminal History
(Yes or No)
Divers License
(Yes or No)
(Yes or No)
(Yes or No)
Military Service
(Yes or No)
Are you currently a member of the National Guard or Reserves?
Work Experience
Please list your work experience for the past 5 years beginning with your most recent job. If you are/were self employed, give company name. Attach Resume if applicable.
Employer #1
Address of Employer
Address of Employer
Phone 2
Phone 2
May we contact this employer?
Employer #2
Address of Employer
Address of Employer
Phone 3
Phone 3
May we contact this employer?
Employer #4
Address of Employer
Address of Employer
Phone
Phone
May we contact this employer?
Employer #4
Address of Employer
Address of Employer
Phone
Phone
May we contact this employer?
Professional References (3)
Name, Position, Company, Phone, Email Address
Name, Position, Company, Phone, Email Address
Name, Position, Company, Phone, Email Address
Plumbing Industry Skills
ONLY select the specific industry skills that you consider yourself to be very knowledgeable about, with a high level of competency.
SYSTEMS:
PIPE:
PARTS/PUMPS/VALVES/FITTINGS:
SERVICE APPLICATIONS:
Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. If you have a resume, please include it with this application. (1 Page Max)
Did you complete this application yourself?
AGREEMENT (PLEASE READ CAREFULLY BEFORE SIGNING)
I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service creates an actual or implied contract of employment. I understand that, if I accept employment with Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service, it will be on an at-will basis. This means that either Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service or I have the right to terminate the employment relationship at any time, for any reason, with or without cause. I agree to submit to drug and alcohol testing, Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service. I release Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service, and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing. I authorize Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service to investigate information concerning my education, licensing, certifications, driving record, criminal history, employment experiences and all other aspects of my background relevant to my proposed employment. I agree to allow Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service to conduct a Background Check contracted by a third-party company. I release Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service and its employees from all liability arising from such investigation.
Name
Name
Date
Date
Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Massie Creek Enterprises, LLC DBA Massie Creek Plumbing & Pump Service depends solely on your qualifications.