Name: *

Phone: *

Address: *

City: *

State: *

Zip Code: *

Email Address: *

If yes, please provide Massachusetts Plumber's license:

Position applied for:

Plumber or Apprentice license number & expiration?

Year first licensed:

Salary Desired:

Has your professional license ever been suspended or revoked? (if yes, explain)

How did you learn of our company and/or position?

List below all present and past employment, beginning with your most recent.

I certify that the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that you shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. I also authorize the companies, schools or persons named above to give any information regarding my employment, character and qualifications and hereby release said companies, schools or persons from all liability for any damage for issuing this information. I further understand that the taking of drug tests, background and driving record checks may be a condition of employment and refusal to take such tests or agree to such investigative reports when required, will subject me to the termination or non-employment. I also understand that no person is authorized to enter into any written or verbal employment contract on behalf or Paul Flaherty Plumbing & Heating Co., Inc. without the express written consent of the president. I understand my employment is at will.

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