T & T Plumbing & Heating Inc
Application for Employment

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
 
Personal Information
 
 
DATE
 
 
 
 
LAST
 
FIRST
 
MIDDLE
 
 
STREET
 
CITY
 
STATE
 
ZIP
 
 
STREET
 
CITY
 
STATE
 
ZIP
 
 
 
 
ARE YOU 18 YEARS OLDER?
 
 
 
 
 
 
 
 
 
 
 
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?
 
 
 
 
 
 
 
 
 

EMPLOYMENT DESIRED
 
 
 
 
 
 
 
 
 
 
 

 
EDUCATION
 
NAME AND LOCATION OF SCHOOL
 
* NO OF YEARS ATTENDED
 
* DID YOU GRADUATE?
 
SUBJECTS STUDIED
 
 
GRAMMAR SCHOOL
 
 
 
 
 
 
HIGH SCHOOL
 
 
 
 
 
 
COLLEGE
 
 
 
 
 
 
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
 
 
 
 
 

EMPLOYMENT DESIRED
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
 
 
 
 
* This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE LAST ONE FIRST).
 
DATE MONTH AND YEAR
 
NAME AND ADDRESS OF EMPLOYER
 
SALARY
 
POSITION
 
REASON FOR LEAVING
 
 
FROM
TO
 
 
 
 
 
 
FROM
TO
 
 
 
 
 
 
FROM
TO
 
 
 
 
 
 
FROM
TO
 
 
 
 
 

REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
 
NAME
 
ADDRESS
 
BUSINESS
 
YEARS ACQUIANTED
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
THE FOLLOWING STATEMENT APPLIES IN: MARYLAND AND MASSACHUSETTS. (Fill in name of state)
 
 
TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
 
 
 
Signature of Applicant
 
 
IN CASE OF
EMERGENCY NOTIFY
 
 
 
 
" I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISINTERPRETATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.
IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."
 
 
SIGNATURE
 

DO NOT WRITE BELOW THIS LINE
 
 
 
 
 
 
 
 
HIRED:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
APPROVED:
 
 
 
 
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.