Chris Delaney, owner

Phone: 937-675-2095

Fax: 937-675-2964


and Bonded

State of Ohio License
# 25797

Master License


































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Employment Application 

Please fill out the application completely. Missing information may delay processing of your application.  

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(s) 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 Walk-In
Employment Agency Relative Other:

 Last Name:
First Name:
Middle Name:
Telephone Number Home:
Telephone Number Work:
Email (required):  

Drivers License #: 

 State (abbreviation):  

1.  Are you 18 years of age or over? 

      If you are under 18 years of age, can you provide required
      proof of your eligibility to work?

Yes  No

Yes No

2. Have you ever filed an application with us before? Yes No
             If Yes, give date:     

3. How many years experience do you have as a plumber?   

4. Are you currently employed? Yes No

  If Yes, please provide the following information:

    Name of Company: 


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 you answered yes, please explain:

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

Questions?  Email or call 937-675-2095

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Revised: November 10, 2008
graphics 2008
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