Job Opportunities

First Name *

Last Name *

Full Address *

Include the street address, apartment/unit #, city, state, and zip code.

Phone *

Email *

Date Available *

Desired Salary *

Position Applied for: *

Are you a citizen of the United States? *

Are you authorized to work in the U.S.? *

Have you ever worked for this company? *

When? *

Have you ever been convicted of a felony? *

Please explain *

High School

Address

Years Attended

Did you graduate?

Diploma

College

Address

Years Attended

Did you graduate?

Diploma

Other Education

Other

Other Address

Years Attended

Did you graduate?

Diploma

Please list three professional references.

Reference 1

Full Name

Company

Relationship

Phone

Address

Reference 2

Full Name

Company

Relationship

Phone

Address

Reference 3

Full Name

Company

Relationship

Phone

Address

Previous Employer 1

Company

Address

Phone

Supervisor

Job Title

Salary

Indicate the starting and ending salary

Job Responsibilities

Dates

Indicate the start to end date

Reason for Leaving

May we contact your previous supervisor for a reference?

Previous Employer 2

Company

Address

Phone

Supervisor

Job Title

Salary

Indicate the starting and ending salary

Job Responsibilities

Dates

Indicate the start to end date

Reason for Leaving

May we contact your previous supervisor for a reference?

Previous Employer 3

Company

Address

Phone

Supervisor

Job Title

Salary

Indicate the starting and ending salary

Job Responsibilities

Dates

Indicate the start to end date

Reason for Leaving

May we contact your previous supervisor for a reference?

Branch

Dates

Indicate the starting and ending dates

Rank at Discharge

Type of Discharge

If other than honorable, explain

Do you have a CDL License?

Date

List all motor vehicle accidents in the past 3 years. Specify date, nature of accident and any injuries it caused.

List all motor vehicle violations other than parking during the past 3 years for which you have been convicted or bond forfeited.

Has your Driver’s License ever been revoked or denied?

If yes, indicate in detail all facts and circumstances

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

Date Signed *

Government agencies require periodic reports on age, sex, ethnicity, handicapped and veteran status of applicants.

This data is for analysis and affirmative action only. Submission of information is voluntary.

Date of Birth

Check one

Male
Female

Race/Ethnic Group

White
Black
Hispanic
American Indian/Alaskan Native
Asian/Pacific Islander

Check all that apply

Check if any of the following are applicable

Vietnam Era Veteran
Disabled Veteran
Handicapped Individual

If Veteran status:

Discharge Date

Federal Job Category

Reporting State

Special Employment Notice to Disable Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Handicaps.

Government contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.

If you wish to be identified, please sign below.

Signature

Interested in joining Imperial Roof Systems?

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High School

College

Other Education

Reference 1

Reference 2

Reference 3

Previous Employer 1

Previous Employer 2

Previous Employer 3

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