Employment Disclosure Please mark which location you are applying for
Address Line 2
State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Attach Resume Do you have a drivers license? What is your means of transportation to work? Educational Background
End Section Employment History
Start Date Employment History Continued
Start Date How did you learn about us? * Is the friend or relative a current or past employee?
What is the name of the current or past employee? * Are you at least 18 years old?
Best time to contact you at home is Have you ever filed an application with us before?
If yes, give date Have you ever been employed with us before?
If yes, give date
Supervisor Do any of your friends, relatives, other than spouse, work here?
If yes, state name, relationship, and location Are you currently employed? May we contact your present employer? Are you legally eligible for employment in the USA? (Proof of citizenship or immigration status will be required upon employment)
If yes, what languages do you speak?
Date available for work Type of employment desired
Hourly range Are you currently on “lay-off” status and subject to recall? Many field roofing positions require employees to transport themselves directly to job site, which might also be outside the range of public transportation. Some field positions require an employee to drive a company vehicle. Do you have a valid drivers license?
If yes, what 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 Washington West Virginia Wisconsin Wyoming Puerto Rico
If yes, what class? Commercial Trade Experience Trade Skills / Certifications Physical Requirements of a Field Position: Ability to lift up to 75 lbs. regularly, often bulky items. Ability to stand/walk, pull, bend over, & work on knees consistently. Ability to work at heights and use ladders. Physically able to tolerate work outdoors at varying temperatures. Are you capable of physically performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job (detailed above) for which you have applied? Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: • Blindness • Deafness • Cancer • Diabetes • Epilepsy • Autism • Cerebral palsy • HIV/AIDS • Schizophrenia • Muscular dystrophy • Bipolar disorder
• Major depression • Multiple sclerosis (MS) • Missing limbs or partially missing limbs • Post-traumatic stress disorder (PTSD) • Obsessive compulsive disorder • Impairments requiring the use of a wheelchair • Intellectual disability (previously called mental retardation) Please check one of the boxes below
Please enter your name
End Section Reasonable Accomodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. References
Do not include family members
Best Time To Call
Best Time To Call
Best Time To Call
Occupation Applicant's Statement EEO Self-Identification Form
End Section Applicant's Statement I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. *