APPLICATION FOR EMPLOYMENT

Beacon Plumbing is an equal opportunity employer. Employment consideration is based on business needs and applicant qualifications and not on race, creed, color, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Please type or print in black or blue ink. Fill out the application completely, do not list see resume or see attached. 
Date: _________________________

I.	Personal Information 
First Name: ___________________________   Last Name: _____________________________
Street Address: ______________________________________________________________________________
City: __________________________________  State: _____________________  Zip Code: ________________
Home Phone: (       )___________________________ Cell Phone: (       )________________________________
Social Security Number or Driver’s License Number: ________________________________________________
Email Address: ____________________________________
•	If hired, can you provide proof that you are legally able to work in the United States?         Yes___  No___
 
•	How were you referred to us? 
Advertisement ___  Referral ____  Employment Agency ____ Walk-In ____  Other _____
 
•	Have you ever been convicted of a criminal offense (felony or misdemeanor)? Note: An affirmative answer will not necessarily result in disqualification for employment:  
Yes___  No___  

If yes, please state nature of offense(s), date(s), city, state and disposition of the offense:
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
 
•	List any relatives or friends employed by Beacon Plumbing & Mechanical, Inc.:
__________________________________________________________________________________________________________________________________________________________________________________

II.	Employment 

•	Position Desired: ____________________________

•	Salary Desired: ________________________
 
•	What days and hours are you available for work? 
_________________________________________________________________________________________

•	Are you available to work overtime if necessary? 
Yes___  No___

•	Are you over 18 years of age? 
Yes___  No___

If you are under 18 years of age, can you provide a work permit? 
Yes___  No___
 
•	When are you available to begin work? _____________________________

•	Are you able to perform the essential functions of the job for which you are applying? Note: We comply with the Americans with Disabilities Act and will consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions:
Yes___  No___

III.	Skills

•	Do you speak, write, or understand any language other than English? 
Yes___  No___

If yes, which language and with what proficiency? _________________________________________________
 
•	Are you able to operate a personal computer?
Yes___  No___

If yes, what types of computer software do you have proficiency in? _________________________________________________________________________________________

List any other office machines you can operate:
 ________________________________________________________________________________________

•	What knowledge, special skills and/or individual capabilities do you have which especially prepare you for the position applied for?
__________________________________________________________________________________________________________________________________________________________________________________

IV.	Education

•	High School or Trade School

Name & City of School: _______________________________________________________________

Number of Years Completed: ___________

Did you graduate?
	Yes___  No___

Degree(s) or Diploma(s): _____________________________________________________________

Major Field(s) of Study: ______________________________________________________________

•	College or University

Name & City of School: ______________________________________________________________

Number of Years Completed: ___________

Did you graduate?
	Yes___  No___

Degree(s) or Diploma(s): _____________________________________________________________

Major Field(s) of Study: ______________________________________________________________

V.	Employment History 
Please account for all employment within the last seven (7) years, beginning with your current or more recent employer. 
1.	Company Name: ___________________________________________________________________

Company Address: _________________________________________________________________

Company Telephone Number: (       )__________________________

Dates Employed: From: ________________  To: ________________

Salary: ______________________________

Job Title: _____________________________

Hours and Days Worked: _____________________________

Supervisor: _________________________________________

Is this your current employer?
	Yes___  No___

	May we contact this employer? 
	Yes___  No___

Specific Job Duties: ____________________________________________________________________________________
____________________________________________________________________________________

Reason for Leaving: ___________________________________________________________________

____________________________________________________________________________________

2.	Company Name: ______________________________________________________________________

Company Address: ____________________________________________________________________

Company Telephone Number: (       )__________________________

Dates Employed: From: ________________  To: ________________

Salary: ______________________________

Job Title: _____________________________

Hours and Days Worked: _____________________________

Supervisor: _________________________________________

Is this your current employer?
	Yes___  No___

	May we contact this employer? 
	Yes___  No___

Specific Job Duties: ____________________________________________________________________________________
____________________________________________________________________________________

Reason for Leaving: ___________________________________________________________________

____________________________________________________________________________________

3.	Company Name: _____________________________________________________________________

Company Address: _________________________________________________________________

Company Telephone Number: (       )__________________________

Dates Employed: From: ________________  To: ________________

Salary: ______________________________

Job Title: _____________________________

Hours and Days Worked: _____________________________

Supervisor: _________________________________________

Is this your current employer?
	Yes___  No___

	May we contact this employer? 
	Yes___  No___

Specific Job Duties: ____________________________________________________________________________________
____________________________________________________________________________________

Reason for Leaving: ___________________________________________________________________

____________________________________________________________________________________

VI.	References
Please list at least three (3) persons NOT related to you who have known you for at least five (5) years. Please provide two (2) professional and one (1) personal reference.

•	Name of Reference #1: __________________________________________________
•	Relationship to Reference: ________________________________________________
•	Address or Email: _______________________________________________________
•	Telephone Number: (       )_______________________

•	Name of Reference #2: __________________________________________________
•	Relationship to Reference: ________________________________________________
•	Address or Email: _______________________________________________________
•	Telephone Number: (       )_______________________

•	Name of Reference #3: __________________________________________________
•	Relationship to Reference: ________________________________________________
•	Address or Email: _______________________________________________________
•	Telephone Number: (       )_______________________

APPLICANT'S STATEMENT
(Initial each numbered item as read)
1.	______ The information that I have provided on this application is accurate to the best of my knowledge and may be verified by Beacon Plumbing & Mechanical, Inc. or its agents. 

2.	______  I authorize all the schools, persons and organizations named in this application to provide any relevant information in their possession or knowledge to the agents of Beacon Plumbing & Mechanical, Inc., for use in deciding whether or not to offer me employment and specifically waive any required written notification. I hereby release Beacon Plumbing & Mechanical, Inc., my former employers and all other persons from any and all claims, demands, or liabilities arising out of or in any way related to such inquiry or disclosure.

3.	______  I understand that Beacon Plumbing & Mechanical, Inc. is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if the Beacon Plumbing & Mechanical, Inc. has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination. 
 
4.	______  I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery.

5.	______ I understand and agree that the employment for which I am applying for is at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or Beacon Plumbing & Mechanical, Inc.. There will be no agreement, express or implied between Beacon Plumbing & Mechanical, Inc. and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by an authorized representative of Beacon Plumbing & Mechanical, Inc..

6.	______ I have placed my signature in the space provided below only after I have completed the entire application to the best of my ability and have carefully read the statements above. 

Applicant Name: _______________________________________
Applicant Signature: ____________________________________
Date: _____________________________