Employment Application                                                         

Please fill out the application completely.  Missing information may delay processing of your application. This application can be printed and faxed to 937-675-2964 or mail application to: 
Delaney Plumbing  
4420 Cherry Grove Road  
Jamestown, OH 45335
 Return to Career  Opportunities.

We Are An Equal Opportunity Employer
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.


Position Applied for:

____   Residential Plumbing Service Technician

____   Commercial Plumbing Service Technician

____   Plumbing Service Technician Helper

Date of Application:

 ______________


How did you learn about Delaney Plumbing?

_____ Advertisement            _____ Friend                  _____ Employment Agency      

_____  Relative                 _____ Other (please specify) ____________________


Last Name:  _________________________________

First Name:  _________________________________    Middle: __________

Address:   ________________________________________________________

City:  ______________________  State:  _____              Zip:  ______________

Home Phone:  __________________   Work Phone:  ____________________

Email:  _________________________________

Driver's License:  ___________________________  State: _____



1.  Are you 18 or age or over  ____ Yes   ____ No

       If you are under 18 years of age, can you provide required proof of your eligibility
     to work?                              ____  Yes  ____  No


2.  Have you ever filled out an application with us before?   ____ Yes  ____  No
                                                                                
                                                                                if yes, give date:  _____________


3.  How many years experience do you have in plumbing?                  _____________


4.  Are you currently employed?                                                 ____  Yes  ____  No

     if yes, please provide the following information:

Company:  _________________________________________________________

Address:  __________________________________________________________

City:  _______________________________  State:  ______  Zip:  ______________

Supervisor:  __________________________   Phone:  _______________________


5.  May we contact your present employer?                                     _____  Yes  _____  No


6.  Are you prevented from lawfully becoming employed in this country because of Visa
     or Immigration status? (Proof of citizenship or immigration status will be required
      upon employment
).                                                                         _____  Yes  _____  No


7.  On what date would you be available for work?  _________________________


8.  Are you available to work

_____  Full-time    _____ Part-time  _____  Shift Work  ______  Temporary


9.  Are you currently on "lay-off" status and subject to recall?  _____  Yes  _____  No


10.  Can you travel if a job requires it?                                             _____  Yes  _____  No


11.  Have you been convicted of a felony within the last 7 years? (Conviction will not
         necessarily disqualify an applicant from employment.)  
  _____  Yes  _____  No

          if yes, please explain: ______________________________________________

__________________________________________________________________

___________________________________________________________________


12.  List any skills, training, or certifications that qualify you for the postion(s):

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

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