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Application

Bodenheimer Plumbing Services, Inc is an equal opportunity employer and adheres to the principles and practices outlined in the Civil Rights Act of 1964, which prohibits discrimination in employment on the basis of race, sex, religion or national origin and Public Law 90-202 which prohibits discrimination based on age.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. This questionnaire is a pre-employment application only.

Consumer Reports Release

In connection with my application for: a) employment (including contract for services), or b) residency, I understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me including consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims and others. These reports will include experience along with reasons for termination of past employment. Further I understand that you will be requesting information from various Federal, State and local agencies which my contain my past activities.

I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above-mentioned information.
I understand I have the right to make a request of the Consumer Reporting Agency, upon proper identification and the payment of any authorized fees, the information in its files on me at the time of my request. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

Date of Birth:



Personal Information

Position Applying for:
Have you ever applied with us before? YesNo
Date available to start:
Have you ever worked under any other name? If so, please give that name:
Have you ever served in the military? YesNo
Service Branch:
Can you lift a minimum of 70 lbs? YesNo
Have you used any illegal drug, including marijuana, in the last twelve months? YesNo
Have you ever had a conviction for driving while intoxicated or under the influence of drugs or alcohol? YesNo
If yes, when?
Are you willing to take a physical exam and drug screen at our expense? YesNo
How many days of leave did you take last year?
How many Fridays and Mondays did you take as leave last year?

Education

Are you planning to pursue further studies? YesNo

If so, when and what courses?

Please list your Strength and Weaknesses:

Employment History

List names of employers in consecutive order with current or last employer listed first.

Name of Employer:
Date Employed: (mm/yy)
Pay:
Reason for leaving:
Duties:

Name of Employer
Date Employed: (mm/yy)
Pay:
Reason for leaving:
Duties:

Name of Employer
Date Employed: (mm/yy)
Pay:
Reason for leaving:
Duties:

Use the space below to describe why you are interested in working for us. List the skills and abilities which you feel particularly qualify you for a position with us.

References

Please list three references, not relatives or former employers

Affidavit

I certify that the answers given by me to the foregoing questions and statements are true and correct without any intentional omissions of consequence of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void, and, if employed, would be cause for my termination. I further agree that you shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. I also authorize the companies, schools or persons named above to give any information regarding my employment, character and qualifications and hereby release said companies, schools or persons from all liability for any damage for issuing this information. I certify that all statements and answers to questions about my abilities are true and were made without reservations. Further I agree to expressly waive all provisions of law prohibiting any physician, person, hospital and other institution from disclosing to us any information regarding treatment rendered now and in the future. I further understand that the taking of a drug test and physical are a condition of employment and refusal to take such tests when requested will subject me to termination. I also understand that no person is authorized to enter into any written or verbal employment contract on behalf of us without the express written consent of the President. I understand my employment is at will. I further understand that I will be given an "Employee Handbook" outlining our rules and regulations.