Senninger Plumbing Co., Inc - Employment Application
Please print document and mail or fax back to us.

Name:___________________________________ | Date:__________________
Address:_________________________________ |
________________________________________ |
SSN:____________________________________ |
Driver's License #:__________________________ |
KY Journeyman's License #:___________________ | Master's License #:__________________________
Phone #:__________________________________ | Emergency #:______________________________

Plumbing Experience

Residential Work: | Rough-in: Y - N | Finish: Y - N |
| Slabs: Y - N | 1 Story: Y - N | 2 Story: Y - N
Commercial Work: | Office Bldg: Y - N | Dentist Office: Y - N | Roof Drains: Y- N
| Acid Piping: Y - N | Apartments: Y - N | Boilers: Y - N
Service Work: | Water Heaters: Y - N | Residential: Y - N | Commercial: Y - N
| Boilers: Y - N | Pumps: Y - N | Cistern: Y - N
| Wells: Y - N | Sewage Pumps: Y - N |
Remodel Work: | Y - N |  |
Utilities Work: | Res. Sewers: Y - N | Storm Sewers: Y - N | Sewer Mains: Y - N
| Water Services: Y - N | Set Manholes: Y - N | Septic Systems: Y - N
| Lay Out: Y - N | Gas Services: Y - N | New: Y - N
| Repair: Y - N |  |

What type of work do you prefer?__________________________________________________
Equipment Experience

Backhoe: Y - N | John Deere: Y - N | Case: Y - N |  |
Jackhammer: Y - N | Trencher: Y - N | Bobcat: Y - N | Cutting Torch: Y - N | Drill: Y - N
Electric Saw: Y - N | Fork Lift: Y - N | Laser Beam: Y - N | Dump Truck: Y - N | Comb: Y - N
Concrete Saw: Y-N | Welder: Y - N | Hoe Ram: Y - N |  |
Capabilities: | Run Crews: Y - N | Layout Jobs: Y - N | Estimates: Y - N |
| Takeoffs: Y - N | Water Test: Y - N | Finals: Y - N |
| Sewers: Y - N | Mechanic Abilities: | Y - N |

Education

Type | School or Company Name & Location | Weeks/Months/Years Completed | Degree/Certificate or Diploma Earned
High School |  |  |
College |  |  |
Technical or Other |  |  |
Specialized Courses related to position |  |  |

If you are hired by the Company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
AUTHORIZATION & APPLICANT STATEMENT: I certify that the facts contained in the application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire or termination if I have been employed, no matter when discovered by the Company.
I understand that any employment is conditional on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employer and references to disclose information regarding my former employment, character, and general reputation to the Company, without giving me prior notice of such disclosures. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands, or liabilities arising out of or related to such an investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promises or guarantee is binding upon the Company unless made in writing.
If I am offered employment I agree to submit to a medical examination (if requested) and a drug screen before starting work. If employed, I also agree to submit to medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examination, which results shall remain confidential and segregated from my personnel file. I understand that my continued employment, to the extent permitted by law, is contingent upon satisfactory medical examination and drug test, and if I am hired, a condition of my employment will be that I abide by the Company's Drug and Alcohol Policy.
I understand that this application will be considered active only for the time period specified by the Company. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.
I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies, and procedures. The Company retains the right to revise its policies or procedures in whole or in part at any time.
Date:________________________ Signature:______________________________________________________
NOTE: If you hold a valid Commercial Drivers License please request part two of the application dealing with information required by the Department of Transportation.

Senninger Plumbing Co., Inc. Affirmative Action Voluntary Information
Senninger Plumbing Co., Inc. considers all applications for positions without regard to race, color, religion, sex, national origin, citizenship, age, disabilities, or veteran status. We do not discriminate on the basis of any unlawful criteria. In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations which may apply, we invite you to complete this application data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide it will not subject you to any adverse personnel decision or action. Your cooperation is appreciated. the information will be used and kept confidential in accordance with applicable laws and regulations.
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APPLICANT INFORMATION |  |
Name:________________________ | Phone #:_______________________
Address:__________________________________________________
Male_______ Female_______ |  |
Position Applied For:_________________________________________
Walk-in:___ | Government Employment Agency:___ | Private Employment Agency:___
Employee:___ | Relative:___ | School:___
Advertisement:___ | Source:_______________________ | Other:_________________________
Name of person who referred you:_________________________________ |
Please check one of the following Equal Employment Opportunity Identification Groups:
White:___ (not of Hispanic origin) | Black:___ (not of Hispanic origin) |
Hispanic:___ | American Indian/Alaskan Native:___ | Asia/Pacific Islander:___
Multiracial:___ (having parents of different races) This identification group is recognized only in the State of Michigan.
Signature:____________________________________ | Date:____________________

Senninger Plumbing Company, Inc.
Invitation To Self Identification For Individuals with Disabilities,
Special Disabled Veterans and Veterans of The Vietnam Era
Senninger Plumbing Co., Inc. is subject to the requirements of the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended (36 USC 4212), and to the requirements of Section 503 of the Rehabilitation Act of 1973, as amended, and their implementing regulations. These Acts and regulations require that Senninger Plumbing Co., Inc. take affirmative action to employ, and to advance in employment, qualified individuals with disabilities, special disabled veterans, and veterans of the Vietnam era.
If you are a person with a disability, a special disabled veteran, or a veteran of the Vietnam era, and would like to be considered under the Affirmative Action Program, please tell us. Providing the information is voluntary. If you do not wish to identify yourself, the information provided will be used only in accordance with the Acts and the regulations. This means that the information provided will be kept confidential, except that: (1) supervisors and managers may be informed of any restrictions on work or duties of the individuals with disabilities or special disabled veterans, and of any necessary accommodations, (2) first aid and safety personnel may be informed when and to what extent appropriate, if a particular handicap or disability may require emergency treatment, (3) government officials investigating compliance with the Acts shall be informed, (4) the information, will be used only in accordance with the Acts and their implementing regulations, and (5) the information will be used to ensure proper placement.
In order to assist us in making proper placement, we ask that if you have a handicap or disability which might affect your performance or create a hazard to yourself or others in connection with the job for which you are applying, you tell us:
(a) what skills and/or procedures you use or intend to use to perform the job notwithstanding that disability, and
(b) what accommodations we could make which would enable you to perform the job properly and safely. This might include special equipment, changes in the physical layout of the job, elimination of certain non-essential duties, or other accommodations.
I certify that I have read the above INVITATION TO SELF IDENTIFICATION and that I understand the terms. I further attest, by checking the appropriate block and signing below that I am:
____ a person with a disability ____ a special disabled veteran ____ a veteran of the Vietnam era ____ none of the above
Signature _____________________________________ Date _______________

Senninger Plumbing Company, Inc.
Application For Employment
Senninger Plumbing Co., Inc. will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin, or for being a Vietnam era veteran, or a special disabled veteran. The Company will take affirmative action to ensure that applicants are employed, and that employees are treated, during employment, without regard to their race, color, sex, or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, or selection for training, including apprenticeship. Senninger Plumbing agrees to post in a conspicuous place, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause.
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Name: ______________________________________ | Social Security #: _______________________________
Present Address: ____________________________________________________________________________
Permanent Address: _______________________________________________________________________
Present Telephone # (____) ______________________ | Permanent Telephone # (____) _________________
Other Telephone # (____) _______________________ |
Position Applied For ____________________________ | Years Experience ________________
Second Choice ________________________________ | Years Experience ________________
Have you previously been employed with Senninger Plumbing Co., Inc. - Yes __ No __
If yes, Where ________________________________ | When __________________ (beginning & ending dates)
Reason for leaving ____________________________ | Supervisor _________________________________
Who recommended Senninger Plumbing to you ____________________________________________________
Do you have any friends or relatives who are employed by the company - Yes __ No __
Please specify (name & relationship) ____________________________________________________________
Date you are available for work ____________________ | Are you available to work overtime - Yes __ No __
Are you available to work out of town - Yes __ No __ | Do you have a valid drivers license - Yes __ No __
Drivers license number __________________________ | State of issue _____________________________
If you are under 18 years of age, can you provide proof of eligibility to work - Yes __ No __

Previous Employment

Dates Mon/Yr | Employer Name, Phone, Address (city/state) | Your Position, Supervisors Name | Base Rate of Pay ($) | Reason for Leaving
From: ________ To: _________ |  |  | $ |
From: ________ To: _________ |  |  | $ |
From: ________ To: _________ |  |  | $ |
From: ________ To: _________ |  |  | $ |
From: ________ To: _________ |  |  | $ |
Are you employed now? _______________ | If yes, may we contact your present employer? ______________

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