J.R.C MECHANICAL, INC. FIELD APPLICATION

First Name: Last Name: Phone: Address: City: State: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip: Positions Applied For: Salary Desired (Hourly): Did You Graduate High School? Yes No     Are You Considered A Journeyman? Yes No     Are You A Master Plumber? Yes No     Are You Currently Working? Yes No     If Yes Where? Have You Ever Worked For JRC Mechanical, Inc.? Yes No If Yes When?

List Your Most Recent Former Employers in Order (Most Recent First)   Company How Long (To/From) Phone Contact Hourly Rate Position Reason For Leaving

Please Answer Each Questions   Are You Familiar With Plumbing Hand Tools? Yes No Are You Familiar With B-Tank & Rig? Yes No Can You Use Saw Zall? Yes No Are You Experienced With Drill(s)? Yes No Can You Use Hole Hawg With Bits? Yes No   Do You Have Your Own Transportation? Yes No Do You Have A Valid VA Driver's License? Yes No Please Select Other Licenses That Apply: NC CDL How is Your Driving Record? Poor Good Great Will You Work Overtime? Yes No   Will You Work Out of Town If The Company Pays Your Expenses? Yes No   Have You Ever Worked As A Lead Plumber? Yes No   Can You Read Blue Prints? Yes No   Can You Operate A Backhoe? Yes No   If Yes, rate Your Experiences With A Backhoe: Some Ok Good   Can You Operate A Mini-Excavator? Yes No   If Yes, Rate Your Experiences With A Mini-Excavator: Some Ok Good   Have You Been Convicted of A Felony In The Last Seven Years? Yes No   If Yes, Please Explain: Give Detailed Description Of Other Plumbing Experiences And Projects Completed: Attach Your Resume: