Application For Employment AN EQUAL OPPORTUNITY EMPLOYER Please answer all appropriate questions completely. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, age, creed, national origin or the presence of disabilities (unless the disability limits your ability to perform the essential functions of the job). Additional job related testing for skills may be required. Testing for the presence of illegal drugs may be required prior to employment. Certain positions may require additional testing and medical reviews to determine job fitness. A medical review will be required (if necessary) only after a job offer has been made. *THIS INFORMATION MAY BE ASKED FOR, BUT YOUR ANSWER IS OPTIONAL. DISCRIMINATION IN ANY MANNER BASED UPON THIS INFORMATION IS PROHIBITED BY FEDERAL LAW. Roofing & Insulation Supply Location First Name Middle Initial Last Name Street Address County City State Zip No. of years at this address Email Addresses for past 3 years Street Address City State Zip Street Address City State Zip Home Telephone Cell/Business Telephone Are you over 18 years of age? Date of Birth* yes Marital Status*    Single    Married    Divorced    Separated    Widowed Have you ever applied for employment with us before? yes    no    Have you ever worked with this company or a related company? yes    no    If yes, when? Position Held: Position Desired: What date can you start? Apart from absence for religious observance, are you available for full-time work? yes    no If not, what hours can you work? Are you legally eligible for employment in the United States?    How did you find out about this position? Driver's License # State Issued Other special training or skills (languages, machine operation, etc.) Emergency Contact Phone Relationship EDUCATION School Name & Location of School Course of Study # of Years Graduate Diploma or Degree Graduate College Business/Trade High School Elementary Have you been convicted of a crime in the last 15 years, excluding misdemeanors?   no yes If yes, explain   Have you served in the Armed Forces? When? Which branch? Status of Discharge yes no What equipment can you operate? (Forklifts, Backhoes, Welders, Computers, Typewriters, Calculators, etc.) EMPLOYMENT HISTORY (Begin with the most recent) Company Name Telephone Address Employed (Month and Year) From To Name of Supervisor Weekly Pay Start Last State Job Title and Describe Your Work Reason for Leaving Company Name Telephone Address Employed (Month and Year) From To Name of Supervisor Weekly Pay Start Last State Job Title and Describe Your Work Reason for Leaving Company Name Telephone Address Employed (Month and Year) From To Name of Supervisor Weekly Pay Start Last State Job Title and Describe Your Work Reason for Leaving I, hereby declare all of the foregoing statements to be complete and true. I understand that as part of normal employment procedures an inquiry may be made concerning information on my character, general reputation, criminal history, credit, and personal characteristics. I authorize such an investigation and understand that upon my request, information as to the nature and scope of the inquiry, if one is made, will be provided. My present employer may or may not be contacted (check response). Any false or misleading statements or material omission in connection with this application may result in termination of any employment by Roofing & Insulation Supply of this applicant. All positions with Roofing & Insulation Supply are terminable "at will" by Roofing & Insulation Supply at any time. Home  |  Products  |  About Us  |  Career Opportunities  |  Contact Us  |  Credit Application  |  Employee Login Web Site Design by Gecko Media