Rooter Master Employment Application
First Name:		Last Name:
Address:
City:		State:
Zip:		Phone:
Email:		Social Security No.:
Employment History
Please list chronologically, beginning with most recent experience.
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Reason for Leaving:
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Reason for Leaving:
Employer:		Address/City:
From (MM/YYYY):		To (MM/YYYY):
Supervisor:		Phone:
Salary:
Reason for Leaving:
Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree High School Select... 7 8 9 10 11 12 College/University Select... 1 2 3 4 More Select... Bachelors Masters Doctorate Other None College/University Select... 1 2 3 4 More Select... Bachelors Masters Doctorate Other None Business or Trade School
Personal Information
Are you legally authorized to work in the U.S.?: (If hired, you will be required to provide proof of work authorization.)		Yes No
Are you at least 18 years of age?:		Yes No
Have you ever been convicted of a crime (felony)?:		Yes No
If yes, give details: (Convictions are not automatic bar to employment)
Are you presently employed?:		Yes No
If so, may we contact your present employer?:		Yes No
If hired, which do you prefer?:		Full-time Part-time
If hired, when would you be available?:
Employment References
List individuals familiar with your job qualifications (No relatives or personal friends).
1) Name of Reference:		2) Name of Reference:
Address:		Address:
City/State/Zip:		City/State/Zip:
Phone:		Phone: