Our Premier Heating
Product
SYSTEM 2000

Employment Application
Name:

 

Email:

 

Phone:

 
Address:

 

Permanent Address

 

Date available

     

Desired salary

 

Position applied for

 
Are you a citizen citizen of the United States? YES      NO
If no, are you authorized to work in the U.S.? YES      NO
Have you ever been convicted of a felony? YES      NO

If yes, explain.
 

 
 

EDUCATION

   

High school

 

Address

 

From To

 

Did you graduate? YES      NO
Degree

 
(area of study, degrees & certifications)


College

 

Address

 

From To

 

Did you graduate? YES      NO
Degree

 
(area of study, degrees & certifications)


Other

 

Address

 

From To

 

Did you graduate? YES      NO
Degree
 

 
(other training or education that applies to employment at Ray Plumbing)
 

LICENSES AND CERTIFICATIONS

Valid Maine YES      NO

License #

 

Other

 
(types and states)

Please select any trade licenses or certifications

 

   

 

Air Conditioning License YES      NO

Other
(Please list)

 

REFERENCES

Please list three professional references:

Full name

 

Relationship

 

Company

 
Phone   Address  

Full name

 

Relationship

 

Company

 
Phone   Address  

Full name

 

Relationship

 

Company

 
Phone   Address  
MILITARY SERVICE

Branch

  From/To  
Rank at discharge Type of discharge
       

If other than honorable, explain:

   
 

PREVIOUS EMPLOYMENT

Company  

Phone

 

Address

 

Supervisor

 

Job title

 

Salary

 
(starting to ending)

Dates

 
(from - to )

Responsibilities

 

Reason for leaving

 

May we contact your previous supervisor for a reference? YES      NO


Company  

Phone

 

Address

 

Supervisor

 

Job title

 

Salary

 
(starting to ending)

Dates

 
(from - to )

Responsibilities

 

Reason for leaving

 

May we contact your previous supervisor for a reference? YES      NO


Company  

Phone

 

Address

 

Supervisor

 

Job title

 

Salary

 
(starting to ending)

Dates

 
(from - to )

Responsibilities

 

Reason for leaving

 

May we contact your previous supervisor for a reference? YES      NO

OTHER INFORMATION

Please write any information about why Ray Plumbing and Heating should consider you for employment.
 

 
DISCLAIMER AND SUBMISSION

By selecting the �accept� button below, I am certifying that my answer are true and compete to the best of my knowledge and I understand that , if employed, falsified or misleading statements on this application shall be grounds for dismissal.

I also authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release Ray Plumbing and Heating from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of Ray Plumbing and Heating has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Ray Plumbing and Heating representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I accept terms listed above.  YES