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?
yes
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?
Are you available for full-time work? yes    no If not, what hours can you work?
Are you currently authorized to accept employment with any employer in the U.S.?   
Will you now or in the future require sponsorship for employment visa status (e.g,. H-1B visa status)?    no yes
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 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, 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.