Experienced | Maxim Roofing Co.

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Applicant Information

Applicant Name:*

Address:*

City, State and Zip Code:*

Telephone Number:*

Email Address:*

Date of Application:*

Employment Position
Position(s) applying for: Foreman, Roofer, Laborer, Other (full time) circle one

How did you hear about this position?

What days are you available for work?

If needed, are you available to work overtime?

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Salary desired:

Personal Information

Do you have any friends, relatives, or acquaintances working for Maxim Roofing Co?*

Yes
No

If yes, state name & relationship:

Are you 18 years of age or older?*

Yes
No

Are you a U.S. citizen or approved to work in the United States?*

Yes
No

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test?*

Yes
No

Do you have any condition which would require job accommodations?*

Yes
No

If yes, please describe accommodations required below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

Yes
No

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: Maxim Roofing Company complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional. )

Education and Training

High School

Name*

Location (City, State)*

Year Graduated*

Degree Earned*

College/University

Name

Location (City, State)

Year Graduated

Degree Earned

Vocational School/Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

Military

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

References
Please provide 2 personal and professional reference(s) below:

Reference

Contact Information

Emergency Contacts

Name:

Relationship:

Phone Numbers:

Name:

Relationship:

Phone Numbers:

Additional Information:

Can you lift up to 70 pounds?

Are you comfortable using ladders?

Do you have a fear of heights?

AT-WILL EMPLOYMENT
The relationship between you and the Maxim Roofing Company is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Maxim Roofing Company. No representative of Maxim Roofing Company has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

CERTIFICATION
I hereby certify to Maxim Roofing Company that all of the foregoing information is true and accurate to the best of my knowledge. I understand that knowingly making false statements on this application can result in my immediate termination from employment.

Applicant Signature:

Dated:

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