Shay Roofing Application

SHAY ROOFING,INC. APPLICATION FOR ROOFING EMPLOYMENT

The following information is requested in order to help us make the best possible placement within Shay Roofing, Inc. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling out this application form. Shay Roofing, Inc. in accordance with State and Federal Laws, does not discriminate on the basis of age, race, color, sex, national origin, veteran status, physical or mental handicap. We also are required by law, by virtue of our contract (s) with the federal government, to take affirmative action to employ women, minorities otherwise qualified handicapped individuals, and Vietnam era and disabled veterans.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Last 4 Digits of SSN
Are you legally entitled to work in the United States?

YesNo
How were you referred to the company?
Have you ever applied for a job with the company?

YesNo
If yes, when and where?
Have you ever worked at the company before?

YesNo
If yes, when?
Position for which you are applying?
Compensation expected?
per (week/month/year/etc.)
Other positions for which you would like to be considered:
Can you work overtime?

YesNo
Can you work shifts?

YesNo
If your application is considered favorable, when can you start?
Is there anything that would prevent you from performing in a safe manner the activities involved in the position for which you have applied or as set forth in attached job description?

YesNo
If yes, please explain:
EDUCATION

Rows	SCHOOL NAME	ADDRESS	# YRS. ATTENDED	DEGREE	MAJOR
HIGH SCHOOL
COLLEGE
GRADUATE
OTHER

Courses now studying:
Military Services Record
Have you served in the U.S. Armed Forces?

YesNo
If yes, list duties in Service, including special training that is relevant to the position for which you have applied.
Employment Record

Please list three (3) most recent position(s)
Most Recent Position
Starting Date:
End Date:
Employer Name:
Employer Address:
Employer Phone:
Description of Duties:
Starting and Ending Salary:
Reason for Leaving:
Supervisor:
2nd Most Recent Position
Starting Date:
End Date:
Employer Name:
Employer Address:
Employer Phone:
Description of Duties:
Starting and Ending Salary:
Reason for Leaving:
Supervisor:
3rd Most Recent Position
Starting Date:
End Date:
Employer Name:
Employer Address:
Employer Phone:
Description of Duties:
Starting and Ending Salary:
Reason for Leaving:
Supervisor:
Personal References

(excluding relatives)
Reference 1:
Name type here
Dates Known type here
Addresstype here
Phone      Phone Number

Reference 2:
Name type here
Dates Known   type here
Address   type here
Phone       Phone Number

Reference 3:
Name   type here
Dates Known   type here
Address   type here
Phone      Phone Number

Reference 4:
Name   type here
Dates Known   type here
Address   type here
Phone      Phone Number
Signature
Date

MonthDayYear
Date
Should be Empty:

SHAY ROOFING,INC. APPLICATION FOR ROOFING EMPLOYMENT

EDUCATION

Military Services Record

Employment Record

Most Recent Position

2nd Most Recent Position

3rd Most Recent Position

Personal References