PCS Plumbing and Heating, Inc. is an equal opportunity employer. PCS Plumbing and Heating, Inc. does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law.

Full Legal Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Are you eligible to work in the United States? *

Are you 18 years of age or older? (If no, you may be required to provide authorization to work.) *

Have you ever been terminated from employment or asked to resign by an employer? *

If yes, please provide company names and details

Can you work any shift? *

If no, explain

Can you work overtime, including weekends? *

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? *

If yes, explain

EMPLOYMENT DESIRED

Date you can start *

Hourly rate / Salary desired *

Position desired *

Are you currently employed? *

If so, may we inquire of your present employer? *

Referral Source

Do you know anyone who works for our company? *

If yes, who?

How did you hear about us? *

Walk in, advertisement, referral, (name)

Have you ever worked for this company before? *

Explain

EDUCATION

High School *

High School Name and Location of School

High School Degree / Certificate Received *

High School Degree / Certificate Received

High School subjects studied *

High School subjects studied

College Name

College Name and Location of school

College Degree Received

Major

Trade School Name

Trade School City and State

Trade School Degree Received

Major

EMPLOYMENT HISTORY Include at least your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Attach additional sheets or write on back where necessary. Do not complete any sections with the words “See Resume.” All sections must be completed regardless of the submission of a resume. Incomplete information could disqualify you from further consideration.

Date Employed From* *

Date Employed To* *

Employment Details *

Full Time
Part Time

Title *

Organization Name* *

Organization Address *

Address Line 1

City

State

Zip Code

Supervisor's Name* *

Supervisor's Title* *

Supervisor's Phone Number* *

Primary Duties *

Reason for Leaving *

Date Employed From* *

Date Employed To *

Employment Details *

Full Time
Part Time

Title

Organization Name* *

Organization Address* *

Address Line 1

City

State

Zip Code

Supervisor's Name* *

Supervisor's Title* *

Supervisor's Phone Number* *

Primary Duties *

Reason for Leaving *

Date Employed From *

Date Employed To *

Employment Details *

Full Time
Part Time

Title

Organization Name *

Organization Address *

Address Line 1

City

State

Zip Code

Date Employed To *

Supervisor's Title *

Supervisor's Name *

Supervisor's Phone Number *

Primary Duties *

Reason for Leaving *

REFERENCES Give the names of three persons not related to you, whom you have known at least three (3) years.

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Company *

Company

Years Acquainted *

Years Acquainted

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Company *

Company

Years Acquainted *

Years Acquainted

Name *

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Company *

Company

Years Acquainted *

Years Acquainted

Other

List other releveant skills *

Please list technical skills, clerical skills, trade skills, etc relevant to the position that you are applying for. Include relevant computer systems, software or apps that you have working knowledge of and note your level of proficiency (basic, intermediate, expert) below:

Why do you want to work at PCS? *

Please tell us why you would like to work for PCS Plumbing and Heating, Inc.

Signature

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for PCS Plumbing and Heating, Inc to hire me. If I am hired, I understand that either PCS Plumbing and Heating, Inc or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of PCS Plumbing and Heating, Inc has the authority to make any assurance to the contrary. I attest with my signature below that I have given to PCS Plumbing and Heating, Inc true and complete information on this application. No requested information has been concealed. I authorize PCS Plumbing and Heating, Inc to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date / Time

Date

Time

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.

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Referral Source

EDUCATION

REFERENCES Give the names of three persons not related to you, whom you have known at least three (3) years.

Other

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