Employment Application Today's Date Driver's License # Full Name Full Address (Street, City, State, Zip) Phone Cell Phone Email Are you 18 or older? Are you 18 or older? Yes No Authorized to work in the United States? Authorized to work in the United States? Yes No Position Applying For Desired Schedule Desired Schedule Full Time Part Time Temporary Specific days / hours available if part time Date available to start work Salary Expectation Have you applied for employment with this company within the last 12 months? Have you applied for employment with this company within the last 12 months? Yes No Have you worked with us before? Have you worked with us before? Yes No If so, please provide your job title and date of previous employment. Shingles Experience Shingles Experience No Experience Some Experience Very Experienced Underlayment Experience Underlayment Experience No Experience Some Experience Very Experienced Tear Off Experience Tear Off Experience No Experience Some Experience Very Experienced Counter Flashing Chimney's Counter Flashing Chimney's No Experience Some Experience Very Experienced Building Saddle's Building Saddle's No Experience Some Experience Very Experienced Siding Experience Siding Experience No Experience Some Experience Very Experienced Soffit Experience Soffit Experience No Experience Some Experience Very Experienced Fascia Experience Fascia Experience No Experience Some Experience Very Experienced Gutters Experience Gutters Experience No Experience Some Experience Very Experienced Gutter Guards/Helmets Experience Gutter Guards/Helmets Experience No Experience Some Experience Very Experienced Metal Trimwork Experience Metal Trimwork Experience No Experience Some Experience Very Experienced Windows Experience Windows Experience No Experience Some Experience Very Experienced Flat Roofing Experience Flat Roofing Experience No Experience Some Experience Very Experienced EPDM Rubber Experience EPDM Rubber Experience No Experience Some Experience Very Experienced Torch On Systems Experience Torch On Systems Experience No Experience Some Experience Very Experienced TPO Systems Experience TPO Systems Experience No Experience Some Experience Very Experienced PVC Experience PVC Experience No Experience Some Experience Very Experienced Duralast Experience Duralast Experience No Experience Some Experience Very Experienced Tile Roofing Experience Tile Roofing Experience No Experience Some Experience Very Experienced Shakes Experience Shakes Experience No Experience Some Experience Very Experienced Loading Roof Experience Loading Roof Experience No Experience Some Experience Very Experienced Packing Hot Experience Packing Hot Experience No Experience Some Experience Very Experienced Spreading Gravel Experience Spreading Gravel Experience No Experience Some Experience Very Experienced Set Rolls Experience Set Rolls Experience No Experience Some Experience Very Experienced Roof Insulation Experience Roof Insulation Experience No Experience Some Experience Very Experienced Build-Up Flashing Experience Build-Up Flashing Experience No Experience Some Experience Very Experienced Tend Kettle & Tanker Tend Kettle & Tanker No Experience Some Experience Very Experienced Mop Experience Mop Experience No Experience Some Experience Very Experienced Roof Decking Experience Roof Decking Experience No Experience Some Experience Very Experienced Safety Training Experience Safety Training Experience No Experience Some Experience Very Experienced Name of Last Employer #1 Address Phone Position Name & Title of Supervisor Employment Start and End Dates Reason for Leaving Brief Description of Your Work & Responsibilities May We Contact This Employer? May We Contact This Employer? Yes No Name of Last Employer #2 Address Phone Position Name & Title of Supervisor Employment Start and End Dates Reason for Leaving Brief Description of Your Work & Responsibilities May We Contact This Employer? May We Contact This Employer? Yes No Name of Last Employer #3 Address Phone Name & Title of Supervisor Position Employment Start and End Dates Reason for Leaving Brief Description of Your Work & Responsibilities May We Contact This Employer? May We Contact This Employer? Yes No High School Name & Location Did you Graduate? Did you Graduate? Yes No Number of Years Completed Diploma / Degree / Certificate College Name & Location Did you Graduate? Did you Graduate? Yes No On-going Number of Years Completed Diploma / Degree / Certificate Technical School Name & Location Did you graduate? Did you graduate? Yes No On-going Number of Years Completed Diploma / Degree / Certificate Graduate School Name & Location Did you Graduate? Did you Graduate? Yes No On-going Number of Years Completed Diploma / Degree / Certificate Special Skills / Additional Training Will you be able to perform the essential functions of your job without reasonable accommodation? Will you be able to perform the essential functions of your job without reasonable accommodation? Yes No Has your employment with any employer ever been involuntarily terminated? Has your employment with any employer ever been involuntarily terminated? Yes No If yes, please identify the employer, date of termination, and reason for termination: First Reference Name Reference Phone Reference Address Years Known Relation to Applicant Second Reference Name Reference Phone Reference Address Years Known Relation to Applicant Your Signature Today's Date Submit
