River Roofing Employment Application

River Roofing, Inc. Employment Application
Date of Application*

MonthDayYear
Date
Name (Last, First, Middle Initial)*
Address*
City*
State*
Zip Code*
Mailing Address (if different)
Phone Number*
What position are you applying for?*
What availability are you looking for? (Enter X on all that apply)
Full Time
Part Time
Temp
Seasonal
Do you have previous roofing experience? (Enter X on Yes or No)
Yes
No
If yes, please explain:
If yes, please explain:

EMPLOYMENT EXPERIENCE
List the last three jobs held, starting with your most recent employer.
1. Employer Name
Start Date

MonthDayYear
End Date

MonthDayYear
Address
Job Title
Phone
Supervisor Name
If still working, may we contact your employer? (Enter X on Yes or No)
Yes
No
If no, please explain:
If no, please explain:
Describe your job responsibilities:
Describe your job responsibilities:
What is your reason for leaving?
2. Employer Name
Start Date

MonthDayYear
End Date

MonthDayYear
Address
Job Title
Phone
Supervisor Name
If still working, may we contact your employer? (Enter X on Yes or No)
Yes
No
If no, please explain:
If no, please explain:
Describe your job duties/responsibilities:
Describe your job responsibilities:
What is your reason for leaving?
3. Employer Name
Start Date

MonthDayYear
End Date

MonthDayYear
Address
Job Title
Phone
Supervisor Name
If still working, may we contact your employer? (Enter X on Yes or No)
Yes
No
If no, please explain:
If no, please explain:
Describe your job responsibilities:
Describe your job responsibilities:
What is your reason for leaving?

Do you have a valid driver's license? (Enter X on Yes or No)
Yes
No
Have you ever been dismissed or forced to resign from a job? (Enter X on Yes or No)
Yes
No
If yes, please explain:
Are you legally authorized to work in the United States? (Enter X on Yes or No)
Yes
No
APPLICANTS STATEMENT
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any false information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I hereby agree to submit to a physical examination prior to beginning employment, including any lawful drug testing that is required. I authorize a thorough investigation of my past employment and activities, agree to cooperate with such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying such information. I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job, in the event I am hired. I further understand and agree that my employment is for no definite period and may, regardless of payment of my wages or salary, be terminated at any time without prior notice, with or without cause.
Full Name*
Date Signed*

MonthDayYear
Date
River Roofing, Inc. is an Equal Opportunity employer and observes all laws prohibiting discrimination. It is River Roofing’s policy to evaluate employees on the basis of their qualifications and merit.
Should be Empty:

River Roofing, Inc. Employment Application

Do you have previous roofing experience? (Enter X on Yes or No)

EMPLOYMENT EXPERIENCE

List the last three jobs held, starting with your most recent employer.

If still working, may we contact your employer? (Enter X on Yes or No)

If still working, may we contact your employer? (Enter X on Yes or No)

If still working, may we contact your employer? (Enter X on Yes or No)

Do you have a valid driver's license? (Enter X on Yes or No)

Have you ever been dismissed or forced to resign from a job? (Enter X on Yes or No)

Are you legally authorized to work in the United States? (Enter X on Yes or No)

APPLICANTS STATEMENT