Employment

PRE-EMPLOYMENT APPLICATION

Mock Plumbing & Mechanical, Inc. is an equal opportunity employer. Mock Plumbing & Mechanical, Inc. prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, national origin, sex (including pregnancy), sexual orientation, gender nonconformity and gender identity), age, disability, service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law.

***PLEASE NOTE-PRIOR TO EMPLOYMENT***
***A DRUG TEST IS REQUIRED***

Personal Information:

Name

Address

City

State

Zip

Phone #:

Are you over 18?

Yes

If under 18, do you have a work permit?

Yes

If not a United States Citizen, do you have a legal right to remain and work permanently in the United States? (Proof of right to work will be required.)

Yes

Job Position:

Position Desired:

Education:

College, Vocational, or Trade Training:

List any professional licenses:

List any certified training:

Driver Licenses:

If the position you are applying for requires you to drive a company vehicle, you will need to have a valid driver's license. During your onboarding process you will be required to complete an MVR and acknowledge our Fleet Policy documents. Mock Plumbing & Mechanical will do a license check through our insurance company.

Availability for Work:

When can you start?

Are you available for full-time work?

Yes

Will you work overtime if asked?

Yes

Do you have reliable transportation to and from the job site?

Yes

General:

Have you ever been convicted of a crime other than a traffic offense? (Conviction of a crime is not an automatic bar to employment - - all circumstances will be considered.)

Yes

If yes, please explain:

Have you ever applied to this company before?

Yes

If yes, when?

Work Experience:

Give chronological statement of position held (most recent position first). State reason for the length of inactivity between employers.

	Employer's name, address, and phone #	Job Title	From Month/Year (mm/yy)	To Month/Year (mm/yy)	Salary	Supervisor/Reason for Leaving

Job Description:

Employee Name:

Job Position:

NOTE: The following is a job description of the position you are applying for, please look this over very carefully and make sure there are no limitations for you to fulfill this position.

In an 8 Hour workday, employee is required to:

		1	3	5	7
A. Sit:	Number of hours
B. Stand:	Number of hours
C. Walk:	Number of hours
D. Walk:	Distance (Min)	1-50’	51-100’	101-300’	300’ +over

In an 8 Hour workday, the employee must:

	Not at all	Occasionally 1%-33%	Frequently 34%-66%	Continuously 67%-100%
A. Bend/Stoop:
B. Squat/Crouch:
C. Crawl:
D. Climb:
E. Reach above shoulder level:
F. Kneel:
G. Push/Pull:
In an 8 Hour workday, the employee must lift:
A. Up to 10 Pounds (Secondary):
B. 10-20 Pounds (Light):
C. 21-50 Pounds (Medium):
D. 51-100 Pounds (Heavy):

On the job, employee uses feet for repetitive movements such as foot controls:

Right: Yes No

Left: Yes No

Both: Yes No

On the job, employee uses hands for repetitive movements such and hand controls:

	Grasping	Grasping & Turning	Fine Manipulation
A. Right	Yes No	Yes No	Yes No
B. Left	Yes No	Yes No	Yes No

Job Requirements:

	YES	NO
A. Inside Work
B. Outside Work
C. Working on heights
D. Around moving machinery
E. Driving automatic equipment
F. Exposure to dust, fumes, gasses
G. Wear Personal Protect Equipment
H. Working outside above 96 degree

I understand that the company may contact all persons, schools, and employers, current or former to verify my employment or obtain information that may be required to arrive at an employment decision. I hereby release the company and the aforementioned that provide such information from any liability. (OTHER THAN WHERE EMPLOYMENT IS GOVERNED BY AN APPLICABLE COLLECTIVE BARGAINING AGREEMENT, I ACKNOWLEDGE THAT MY EMPLOYMENT MAY BE TERMINATED WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT THE OPTION OF EITHER THE COMPANY OR MYSELF.) I understand that no representative of the company has the authority to enter into any agreement for employment for a specified period of time or to make any agreement that contradicts or modifies the foregoing in any manner.

I acknowledge that consent to and successful completion of a drug test upon request at any time is a condition of employment and continued employment with the company. I hereby release the company and any other company or individuals who administer and/or act in reliance upon the results of any drug test.

I hereby declare the information provided by me in this application for employment as true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for discharge.

Signature:

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PRE-EMPLOYMENT APPLICATION

Safety Program

Policy Manual

Safety Incentive Program