APPLICATION

FOR EMPLOYMENT

TEAMCRAFT ROOFING
Position(s) applied for

Date of application

Referral Source

Advertisement
Walk-in

Employee
Relative

NAME
NAME

Government Employment Agency

Private Employment Agency

Other

Name

LAST

FIRST

Other Names Used

Address
Telephone # (

STREET

MIIDDLE

CITY

STATE

ZIP CODE

Alternate Phone # (____)_______________________ Email: _____________________________

May we contact you at work?................................................................................................... Yes

If yes, work number and best time to call (

If you are under 18 and it is required, can you provide a work permit?............................................................ Yes

No

AM/PM

No

If no, please explain

Have you previously submitted an application to The Company?.................................................................... Yes
If yes, give date(s):

From

Do you have friends or relatives working here?

To

Yes No

From

No

No

If yes, give names:

Have you ever been employed here before?.............................................................................................. Yes

If yes, give date(s):

To

Reason for Leaving

Are you legally eligible for employment in this country?.............................................................................. Yes

Date available for work ............................................................................................................

Type of employment desired

Full-Time

Part-Time

No

Temporary

What hours are you available for work?

Will you work overtime if required?....................................................................................................... Yes

No

No
No

If no, please explain

Will you relocate if job requires it? Yes No Will you travel if job requires it?................................... Yes
Have you ever been convicted of a crime in the last seven (7) years?............................................................... Yes
If yes, please explain

CONVICTION WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH INSTANCE AND EXPLANATION WILL BE CONSIDERED IN RELATION TO THE POSITION FOR WHICH YOU ARE
APPLYING.

Driver's license number if driving is an essential job function

An Equal Opportunity Employer

State

Employment History
Provide the following information for your past and current employers, assignments or volunteer activities, starting with the most recent
(use additional sheets if necessary). Explain any gaps in employment. List all employment within the last ___ years.
EMPLOYER

TELEPHONE
( )

DATES EMPLOYED
FROM

ADDRESS

MO/YR

JOB TITLE

TO

SUMMARIZE THE TYPE OF WORK

PERFORMED AND JOB RESPONSIBILITIES

MO/YR

HOURLY RATE/SALARY
STARTING

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING

PER
HOURLY RATE/SALARY
FINAL

MAY WE CONTACT FOR REFERENCE?

EMPLOYER

YES

NO

LATER

TELEPHONE
( )

PER
DATES EMPLOYED
FROM

ADDRESS

MO/YR

JOB TITLE

TO

SUMMARIZE THE TYPE OF WORK

PERFORMED AND JOB RESPONSIBILITIES

MO/YR

HOURLY RATE/SALARY
STARTING

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING

PER
HOURLY RATE/SALARY
FINAL

MAY WE CONTACT FOR REFERENCE?

EMPLOYER

YES

NO

LATER

TELEPHONE
( )

PER
DATES EMPLOYED
FROM

ADDRESS

MO/YR

TO

SUMMARIZE THE TYPE OF WORK

PERFORMED AND JOB RESPONSIBILITIES

MO/YR

HOURLY RATE/SALARY
STARTING

JOB TITLE
IMMEDIATE SUPERVISOR AND TITLE

PER
HOURLY RATE/SALARY

REASON FOR LEAVING

FINAL

MAY WE CONTACT FOR REFERENCE?

EMPLOYER

YES

NO

LATER

PER

TELEPHONE

ADDRESS

DATES EMPLOYED
FROM

MO/YR

JOB TITLE

SUMMARIZE THE TYPE OF WORK

PERFORMED AND JOB RESPONSIBILITIES

MO/YR

HOURLY RATE/SALARY
STARTING

IMMEDIATE SUPERVISOR AND TITLE

REASON FOR LEAVING

MAY WE CONTACT FOR REFERENCE?

TO

PER
HOURLY RATE/SALARY
FINAL

YES

NO

LATER

PER

Gaps in Employment (Account for all periods of unemployment of three months duration or more in the above employment history,
excluding periods of time when you were a full-time student.)
From

To

MO/YR

MO/YR

MO/YR

MO/YR

MO/YR

MO/YR

State What You Were Doing

An Equal Opportunity Employer

Educational Background
A. List last three (3) schools attended, starting with most recent. B. List number of years completed. C. Indicate degree or diploma
earned, if any. D. Grade Point Average or Class Rank (if known). E. Major field of study. F. Minor field of study.
B. NUMBER OF
YEARS COMPLETED

A. SCHOOL

Name
City & State
Name
City & State
Name
City & State
Name

C. DEGREE
DIPLOMA

TYPE

YEAR

TYPE

YEAR

TYPE

YEAR

TYPE

YEAR

D. GPA/
CLASS/RANK

E. MAJOR

F. MINOR

City & State

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in
the position for which you are applying. You may wish to include foreign language skills, typing skills, PC skills, software used, office
equipment, etc.

Additional Information
List professional, trade, business or civic associations, special accomplishments, publications or awards.

EXCLUDE MEMBERSHIPS AND INFORMATION WHICH WOULD REVEAL SEX, RACE, RELIGION, NATIONAL ORIGIN, AGE, COLOR, DISABILITY OR ANY OTHER SIMILARLY PROTECTED
STATUS.

List any additional information you should like us to consider:

REFERENCES
List name and telephone number of three business/work references that are not related to you. If not applicable, list three school or
personal references that are not related to you.
NAME

HOW KNOWN
(
(
(

TELEPHONE
)
)
)

YEARS KNOWN

IN CASE OF
EMERGENCY, NOTIFY:
NAME

ADDRESS

An Equal Opportunity Employer

TELEPHONE

AS AN APPLICANT I UNDERSTAND AND AGREE TO THE FOLLOWING:

The Company does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age,
disability, veteran status or status within any other protected group. No questions on this application are intended to secure information
to be used for such discrimination. Pursuant to the Americans with Disabilities Act, it is The Company's policy to hire qualified
individuals with a disability as long as the individual can perform the essential functions of the job, with or without a reasonable
accommodation.
In connection with The Company's consideration of me for employment, continued employment, promotion or reassignment or
as part of an investigation, I understand that The Company or persons acting on its behalf may conduct investigative inquiries into my
background that will include information regarding job reference, personal reference, criminal, consumer credit, driving, and other
reports pertaining to me. These inquiries may include personal conversations with persons possessing knowledge relevant to these
categories. These background inquiries will be conducted and reports obtained to provide The Company with job-related information
regarding my character, general reputation, personal characteristics, work record and characteristics, skills and abilities, education and
training, employment and experience, past job performance, reasons for termination of previous employment and other pertinent
information.
I hereby consent to The Company, or persons acting on its behalf, obtaining the above stated information, I authorize, without
reservation, any person or entity contacted by The Company or anyone acting on its behalf to furnish the above-stated information, and I
release any such person or entity from any and all liability for furnishing such information. I also release The Company from any and all
liability for conducting such an investigation. I understand that I have the right to make a written request within a reasonable period of
time to receive additional detailed information about the nature and scope of the investigation(s).
In addition to authorizing the release of any information regarding my employment and background, I hereby fully waive any
rights or claims that I have or may have against my former employers, their agents, employees and representatives regarding the release
of information and release them from any and all liability, claims, or damage that may directly or indirectly result from the use,
disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me.
I authorize The Company or persons acting on its behalf to make these investigations, and to use job-related information obtained
in its employment decision, including but not limited to, the truthfulness of my responses to The Company's employment inquiries. I
hereby state that all information that I provide on this application and in any interview is true and accurate. I am aware that false
statements, misrepresentations of facts, or material omissions may be sufficient to disqualify me for employment, or if employed, may
result in my termination.
I have not signed any employment agreement or other agreement which limits the type of job I might accept in the future, or
which limits for whom I might work in the future, with any employer by whom I have been employed at any time during the past two (2)
years. If a job offer is extended, my initial and continued employment will be conditioned upon execution of agreements, if appropriate,
with regard to invention, patent, confidentiality and non-competition. I also understand that after receipt of a job offer from The
Company, I may be required as a condition of employment to submit to a medical examination and/or a drug test. Applicants for
employment may be sent to a designated facility to undergo a drug-use test as part of the pre-employment process.
If employed, I will be required to provide proof of identity and legal work authorization, and I must meet minimum age
requirements of applicable laws. I understand and acknowledge that there have been no oral or written representations made promising
or guaranteeing employment or continued employment.
I understand that nothing contained in this application, offer letter, or in the interview process is intended to create an employment
contract between The Company and me. If I am employed, I have a right to terminate my employment at any time and for any reason.
Similarly, The Company may terminate my employment at any time, with or without notice and with or without cause. The Company is an
at-will employer. I further understand that no representative of The Company has any authority to enter into any agreement with me for any
specified period of time or to guarantee some other benefit, other than the President and any such agreement must be in writing to be
effective. Supervisors do not have authority to make oral agreements guaranteeing employees future promotions, pay raises, benefits,
reassignments or transfers. Any such assurances must be in writing and signed by the President to be enforceable. This statement applies to
the period prior to or after I may be employed.
I understand that my application for employment will be considered active for 60 days. After the expiration of 60 days, and, if I
still desire to be considered for employment, it will be necessary for me to complete a new application.
Signature of Applicant:

Applicant Name:

Date: ______________________________________________
An Equal Opportunity Employer

(Print)

Employee/Applicant Self Identification Form

The information below is used by the company only to maintain records required of employers pursuant to federal
regulations. Any information supplied by you will not affect your employment with the Company. The Company is
an Equal Opportunity Employer.
The Company complies with various federal and state laws and regulations that require the Company to file annual
statistical reports on applicants and employees at the Company. In order to assist us in reporting accurate
information and in analyzing the effectiveness of our diversity initiatives, we request your voluntary cooperation of
self-identifying your race and ethnicity, and veteran status.1 In extending this invitation you are also advised that:
(a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses
will remain confidential within the Human Resources Department; and (c) responses will be used only for the
necessary reporting and implementation of the Companys affirmative action obligations, if you are eligible and
would like to be considered for participation. Filling out this form is voluntary and will have no impact on any
hiring decision. Refusal to complete this form will not result in adverse action. You may self-identify at any time
now or in the future.
Name (please print):
Position Applied For:___________________________________
How did you hear of our opening?

Current Employee

Government Employment Agency

Newspaper Ad

Walk-In

Recruiter/Private Employment Agency

Other - Explain:________________________________

I do not wish to self-identify.

Race and Ethnicity:

Two or More Races (Not Hispanic or Latino)
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial
groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of
the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
1

The information on this form is compiled based on federal regulations requiring the Company to summarize
and submit an annual report regarding the above classification. The reports do not identify any specific
individual. The form is confidential and is generally maintained in a separate, limited access file and should
not generally be maintained in an employees personnel file.
An Equal Opportunity Employer

 Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the
original peoples of North and South America (including Central America), and who maintain tribal
affiliation or community attachment.
Other (specify)
Gender:
Male
Female
Veteran Status: (if applicable)
Armed Forces Service Medal Veteran - A veteran who:
while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States
military operation for which an Armed Forces service medal was awarded pursuant to Executive Order
12985
Other Protected Veteran - Any veteran who served on active duty in the U.S. military,
ground, naval, or air service, during a war or in a campaign or on an expedition for which a
campaign badge has been authorized under the laws administered by the Department of
Defense.
Recently Separated Veteran - A veteran who is in the three year period beginning on the
date of such veterans discharge or release from active duty in the U.S. military, ground,
naval or air service.
After being hired, an individual will be provided the opportunity to self-identify as a Special Disabled
Veteran - A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or
who but for the receipt of military retired pay would be entitled to compensation) under laws administered
by the Secretary of Veterans Affairs or a person
who was discharged or released from active duty because of a service-connected disability.

Signature:

Date:

An Equal Opportunity Employer