Print Page Applicant Information Last Name First M.I. Date Street Address Apartment/Unit # City State Zip Phone E-mail Address Date Available Desired Salary Position Applied for Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company? Yes No If so, when? Are you currently working? Yes No If yes, Where? Do you have a valid Washington State driver's license? Yes No What is your means of transportation to work? Driver’s license number State of issue Expiration date Have you had any accidents during the past three years? How many? Have you had any driving violations (tickets) during the past three years? Yes No How many? Education High School Address From To Did you graduate? Yes No Degree College Address From To Did you graduate? Yes No Degree Other Address From To Did you graduate? Yes No Degree Licenses Please list all plumbing/apprentice licenses and expiration dates Apprentice License Yes No License # Expiration Date: Journeyman License Yes No License # Expiration Date: Other Yes No License # Expiration Date: References Please list three professional references. Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Previous Employment Company Phone Address Supervisor Job Title Responsibilities Starting Salary $ Ending Salary $ From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Responsibilities Starting Salary $ Ending Salary $ From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Responsibilities Starting Salary $ Ending Salary $ From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Responsibilities Starting Salary $ Ending Salary $ From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Responsibilities Starting Salary $ Ending Salary $ From To Reason for Leaving May we contact your previous supervisor for a reference? Yes No Military Service Branch From To Duties Rank at Discharge Type of Discharge If other than honorable, explain Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature Date
