Online Employment Application Form

PERSONAL INFORMATION
Name*
First Last
Email*
Enter Email Confirm Email
Mobile Phone*
Drivers License Number
Drivers License State of Issue
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Social Security Number*

EMPLOYMENT DESIRED
Position(s) applying for*
Date you can start*
Date Format: MM slash DD slash YYYY
Are you currently employed*
- Yes
- No
Current Employer
May we contact your current employer?*
- Yes
- No
Name of Supervisor
Current Pay
Compensation Desired*
Available to work*
- Full-Time
- Part-Time

EMPLOYMENT HISTORY
List below your recent employers, starting with your present one first. Be sure to account for all periods of time.
1) Most Recent/Current Job
1) Date Job Started
Date Format: MM slash DD slash YYYY
1) Date Job Ended
Date Format: MM slash DD slash YYYY
1) Employer/Business Name
Job 1) Wage Rate
1) Position
1) Reason for Leaving
2) Second Most Recent Job
2) Date Job Started
Date Format: MM slash DD slash YYYY
2) Date Job Ended
Date Format: MM slash DD slash YYYY
2) Employer/Business Name
2) Wage Rate
2) Position
2) Reason for Leaving
3) Third Most Recent Job
3) Date Job Started
Date Format: MM slash DD slash YYYY
3) Date Job Ended
Date Format: MM slash DD slash YYYY
3) Employer/Business Name
3) Wage Rate
3) Position
3) Reason for Leaving
4) Fourth Most Recent Job
4) Date Job Started
Date Format: MM slash DD slash YYYY
4) Date Job Ended
Date Format: MM slash DD slash YYYY
4) Employer/Business Name
4) Wage Rate
4) Position
4) Reason for Leaving
Have you ever been involuntarily terminated or asked to resign from any job?
- Yes
- No
If you have been terminated or resigned, please explain
Please explain any gaps in your employment history
Please list any other experience, job related skills, additional languages, or other qualificationsthat you believe should be considered in evaluating your qualifications for employment.

BUSINESS AND PROFESSIONAL REFERENCES
1) Name
1) Title
1) Business Relationship
1) Telephone Number or Email
2) Name
2) Title
2) Business Relationship
2) Telephone Number or Email
3) Name
3) Title
3) Business Relationship
3) Telephone Number or Email

CO-WORKER REFERENCES
1) Name
1) Title
1) Number of Years Acquainted
1) Relationship
1) Number of Years Acquainted
2) Name
2) Title
2) Relationship
2) Number of Years Acquainted
2) Telephone Number or Email
3) Name
3) Title
3) Relationship
3) Number of Years Acquainted
3) Telephone Number or Email

APPLICANT STATEMENT AND AGREEMENT
Please read and initial each paragraph below. If there is anything that you do not understand, please ask.
Consent to Investigate my references, work record, education, and matters related to employment*
I hereby authorize Nieman Plumbing Inc. to thoroughly investigate my references
I hereby authorize Nieman Plumbing Inc. to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references have listed to disclose to Nieman Plumbing Inc. any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release Nieman Plumbing Inc., my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
Rules and Regulations Compliant*
I agree to comply with all Nieman Plunbing Inc., rules and regulations
In the event of my employment with Nieman Plumbing Inc., I understand that I am required to comply with all rules and
regulations of Nieman Plumbing Inc.
At-Will Employment*
I agree my employment with Nieman Plumbing Inc. is an at-will employment
If hired, I understand and agree that my employment with Nieman Plumbing Inc. is at-will, and neither I nor Nieman Plumbing Inc. is required to continue the employment relationship for any specific term. I further understand that Nieman Plumbing Inc. or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
Safety Compliance*
I agree to follow all Nieman Plumbing Safety Procedures
I understand that the safety of employees is extremely important to Nieman Plumbing Inc. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
True and Correct Answers*
I agree, my answers are true and correct
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
Identity*
I agree to provide identity and I can legally work in the USA.
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and those federal immigration laws require me to complete an I-9 Form in this regard.
MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS AND THAT ALL INFORMATION I PROVIDED IN MY APPLICATION FOR EMPLOYMENT IS TRUE, ACCURATE AND COMPLETE.
Digital Signature
Enter your complete legal name to sign this document digitally.
Printed Name
First Last
Signed Date
Date Format: MM slash DD slash YYYY
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Cincinnati's Plumber

Online Employment Application Form

Step 1 of 8 - Personal Information

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EMPLOYMENT HISTORY

1) Most Recent/Current Job

2) Second Most Recent Job

3) Third Most Recent Job

4) Fourth Most Recent Job

EDUCATION

High School

College or University

Graduate or Professional

Trade, Vocational, or Online School

BUSINESS AND PROFESSIONAL REFERENCES

CO-WORKER REFERENCES

GENERAL INFORMATION

APPLICANT STATEMENT AND AGREEMENT