Application for Employment

(PLEASE PRINT OR TYPE)

Position(s) Applied For

Date

Last Name

First Name

Middle/Maiden Name

Address

Ciy

State

Zip Code

Telephone

Social Security No.

Have you ever filled out an applicaion here before?

Yes No

If yes, give dates and position applied for

Have you ever been employed here before?

Yes No

If yes, give dates and position held

Have you ever been convicted of a crime other than a minor traffic violation?

Yes No

If yes, please explain. (A "yes" answer to this question does not necessarily preclude consideration for employment).

What is the earliest date you could begin work?

Will you be able to perform the requirements of the position for which you are applying?

Yes No

What knowledge, special technical or computer skills, and/or other qualifications have you acquired from employment or other experience? Include any specific equipment that you can proficiently operate :

Employment History

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Employer

Address

Phone

Job Title

Supervisor's Name

No. Supervised By You

Start Date (mo/yr)

Starting Salary/Wage

Ending Salary/Wage

End Date

Hours Worked Per Week

Reason for Leaving

Duties

Equal Employment Opportunity Form

Federal law prohibits discrimination based on race, color, religion, sex, age, disability, national origin, and veteran status. The following information is used for record keeping purposes in accordance with Equal Employment Opportunity Commission requirements. Complete the following information sheet and return it with your application blank. Please type or print and sign below. You are not required to furnish this information but we encourage you to do so.

Position(s) Applied For:

(1)

(2)

Last Name

First Name

Middle/Maiden Name

Date of Birth

Male Female

Referral Source (Who referred you to us?):
Newspaper Ad
Walk In
Employment Agency

Racial Identification:
White
Black
Asian/Pacific Islander(Includes: Far East, Southeast Asian, Indian Subcontinent, and The Pacific Islands)
American Indian
Hispanic (Includes: Mexican, Puero Rican, Cuban or Spanish origin)
Other (please specify)

Are you handicapped? Yes No

Are you a disabled veteran? Yes No

Are you a Vietnam-era veteran? Yes No

Citizenship

Visa Type

Visa Date

Electronic Signature

Date

I decline to provide this information. Electronic Signature

Date

Education

Schools	Name	Location of School	Did You Graduate?	Semester or Quarter hrs Completed	Degrees Recieved	Major/Minor
High School
College(s)/University(ies)
Graduate or Professional
Other educational, Vocational schools, Internships, etc.

Honors Received

Professional Organizations

References

Give name, address, and telephone number of three references who are qualified to evaluate your prior performance.

List any other names under which you have been employed or attended school to facilitate accurate reference checking.

State any additional information you feel may be helpful to us in considering your application.

Agreement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application as may be necessary in arriving at an employment decision and release East Carolina Ventures, LLC dba Eastern Plumbing from all liability arising from such inquires.

In the event of employment, I understand that false or misleading information given in my application or interview(s) will result in discharge. I understand, also, that I am required to abide by all rules and regulations of Eastern Plumbing.

Electronic Signature

Date

Eastern Plumbing

Applicants are considered for all positions without regard to race, color, religion, sex, age, disability, national origin and veteran status.

If not submitted online, please return to:
4736 NC Highway 43 South
Greenville NC 27858
Phone: 252-758-7589
Fax: 252-757-3446

(PLEASE PRINT OR TYPE)

Employment History

Equal Employment Opportunity Form

Education

References

Agreement

Eastern Plumbing

Application for Employment

Applicants are considered for all positions without regard to race, color, religion, sex, age, disability, national origin and veteran status.

If not submitted online, please return to: 4736 NC Highway 43 South Greenville NC 27858 Phone: 252-758-7589 Fax: 252-757-3446

(PLEASE PRINT OR TYPE)

Employment History

Equal Employment Opportunity Form

Education

References

Agreement

If not submitted online, please return to:
4736 NC Highway 43 South
Greenville NC 27858
Phone: 252-758-7589
Fax: 252-757-3446