Lamont Plumbing, Inc.

1814 Zapata

Freeport, TX 77541

Application for Employment

Lamont Plumbing, Inc. is an equal opportunity employer dedicated to a policy of compliance with all federal, state and local laws regarding non-discrimination in employment.

Desired Position: Date:

Salary: Date you can start:

Personal Information

Name:

LastFirstMiddle

Address:

Street/AptCityStateZip

Home Phone: Alt. Phone:

Social Security #:Are you at least 18 years old? YesNo

Do you have a TX driver’s license?YesNo

If yes, license #:Expiration date:

If hired, do you have reliable transportation to/from work?YesNo

How were you referred to Lamont Plumbing, Inc?

General

Do you speak a foreign language(s)?Read:Write:

Special training skills:

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

If no, please describe the function(s) that cannot be performed:

Have you ever been convicted of a criminal offense (felony/misdemeanor)?

If yes, please explain:

Employment History

(Please begin with most present employer)

Dates / Name/Address/Phone / Position / Salary / Reason for leaving

May we contact your past employers?

Education

(Please list only high school, college and vocational schools)

Name / Years Attended / Graduate / Subjects Studied

U.S. Military or Naval Service:Rank:

Present membership in National Guard/Reserve:

References

(Please list only non-relatives that you have known for at least two (2) years)

NameAddressYrs. KnownPhone

1.

2.

3.

*If extended an offer of employment, I consent to undergo a substance abuse test in accordance with Lamont Plumbing, Inc. policy. A copy of Primary Plumbing Service’s Substance Abuse Policy shall be provided to all applicants prior to administering the test.

Initials

*I certify that all of the statements in this application are true and completed to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you and all information concerning my previous company form all liability for any damage that may result form utilization of such information. I also understand and agree that my employment is for definite period and may, regardless for the date of payment of my wages and salary, be terminated at any time without any previous notice.

Initials

Comments

Signature:Date: