Name: Address: City: State: Select a state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Washington Wisconson Wyoming Zip Code: E-mail Address: Phone Number (main number):
Area of Interest: Sheet Metal Fabrication Flat Roof Technician Tile Roof Installer General Laborer
Position Desired: Salary Desired: Are you presently employed? yes no If yes, may we inquire with your present employer? yes no
Have you ever applied to this company before? yes no If yes, where? when?
Have you ever worked for this company before? yes no If yes, where? when? What was your reason for leaving? What was the name of your last supervisor?
Please fill out the name of schools you have attended.
High School:
Name:
Location:
Years you attended this school:
Did you graduate? yes no
University / College:
What did you study?
Other schools attended:
Please list your last two employers, starting with the most recent.
Present / Last Employer: Phone Number: Address: City: State: Zip Code: When were you employed? From: To: Job Title: Salary: Name of Supervisor: May we contact your supervisor? yes no Description of Work: Reason for Leaving:
Previous Employer: Phone Number: Address: City: State: Zip Code: When were you employed? From: To: Job Title: Salary: Name of Supervisor: May we contact your supervisor? yes no Description of Work: Reason for Leaving:
ave you ever been convicted of a felony within the last five years? yes no If yes, please explain: A "yes" answer will not necessarily disqualify you from consideration.
Authorization "I understand that the foregoing is a preliminary questionnaire and that, prior to being considered for employment, I will be required to complete an application.
I certify that the facts contained in this true and complete the best of my knowledge and understand that, if employed, falsified statements on this questionnaire shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
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