Online Application

PERSONAL INFORMATION
First Name Middle Initial Last Name
Present Street Address Apt #
City State Zip Code
Telephone Number E-Mail Address
Social Security Number Are you at least 18 years old?
Yes     No
Previous Address (if at present address less than 12 months) Apt #
City State Zip Code
Position Desired: Experienced?
First Choice: Yes No
Second Choice: Yes No
Third Choice: Yes No
Salary Requirement: $ Do you have adequate means of transportation to get to work on time each day and when called in on short notice? Yes     No
Date Available for Work:
Are you willing to travel? Yes     No If overtime work is required periodically, does this pose a problem for you? Yes     No
Are you willing to relocate? Yes     No

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

 Yes     No
Have you ever worked in a facility associated with Empire Roofing? If yes, what facility? Are you related to another Empire Roofing employee?
Yes     No Yes     No
How did you learn about this position? State Employment Commission
Agency
Job Listing
Current Employee
Other: 		Advertisement
School
Job Line
Internet Site
Are you able to perform the essential, job related functions of the position for which you are applying with or without accommodations? Yes     No Please describe any
accommodations necessary:
Have you ever been convicted of a crime and/or released from confinement following a conviction following any criminal offense? Yes     No
Arrest or charges that have been expunged need not be disclosed.
If yes, give date, place, and nature of each such conviction:
Date:
Date:		 State:
State: 		Nature:
Nature:
Are you presently charged with any violation of the law? Yes     No
If yes, give date, place, and nature of each such charge:
Date: 		State: Nature:
Date:   State: Nature:
EDUCATIONAL HISTORY
School Name and Location of School Check Last Year
Attended in School		 Degree or Certificate
High School
9  10  11  12
Graduated/GED?
Yes    No
College/
University
1  2  3  4
Graduated?
Yes    No
College/
University
1  2  3  4
Graduated?
Yes    No
Graduate
School
1  2  3  4
Graduated?
Yes    No
     
Other
From
To    
LICENSURE/CERTIFICATION
Profession in which you are licensed, registered, or certified:
Original registration, certification, license number:      Date:
 
Other pending license:     Type: State:  Expected Date:
Clerical or other skills
applicable to the position for which you are applying:		 Typing  wpm
PBX
 Business
Machines/Equipment:		 Proficient in Software:


EMPLOYMENT HISTORY
Please list all present and past employment beginning with your most recent position (including self-employment and military experience). Please provide the most recent 10 years of employment history.
From To Company Phone Number Supervisor
Month Year
 Month
 Year
Salary Company Address May we
contact them?		 Name while employed
$ Yes    No
Job Title City/State Reason for Leaving
Nature of Duties
From To Company Phone Number Supervisor
Month Year
 Month
 Year
Salary Company Address May we
contact them?		 Name while employed
$ Yes    No
Job Title City/State Reason for Leaving
Nature of Duties
From To Company Phone Number Supervisor
Month Year
 Month
 Year
Salary Company Address May we
contact them?		 Name while employed
$ Yes    No
Job Title City/State Reason for Leaving
Nature of Duties
From To Company Phone Number Supervisor
Month Year
 Month
 Year
Salary Company Address May we
contact them?		 Name while employed
$ Yes    No
Job Title City/State Reason for Leaving
Nature of Duties
PROFESSIONAL REFERENCES (Other than Relatives)
Please provide two references who have good knowledge of your work.
Name Position Address/City/State Phone (Home/Work) Years Known



Voluntary EEO Self-Identification Form
Empire Roofing is an equal employment opportunity/affirmative action employer. Certain laws and regulations regarding equal employment opportunity/affirmative action require us to compile annual statistical reports on applicants for employment. In order to comply with these laws and regulations, we are requesting your cooperation in completing this EEO Self-Identification Form.

This information on this EEO Self-Identification Form is being requested and will be used solely for equal employment opportunity/affirmative action record-keeping and reporting purposes. Submission of this form by you is voluntary. Please be assured that you will not be subjected to any adverse treatment if you do not provide the information requested. In the event that you do provide the information requested, the information and this form will be processed and maintained separately from your employment application forms and, if you are hired by the Company, your personal file.
Sex Identification Ethnic Identification Minority Status Identification
Male
Female 		Hispanic or Latino
Not Hispanic or Latino 		White (Not of Hispanic Origin)
Black (Not of Hispanic Origin)
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
Position Sought:
Name:
Date:

ALL APPLICANTS MUST READ AND CHECK EACH OF THE FOLLOWING BOXES ACKNOWLEDGING THE TERMS AND CONDITIONS OF EMPLOYMENT AT EMPIRE ROOFING.

In making application for employment:

I certified that the information in this application is true and complete for all practical purposes. It may be verified by Empire Roofing or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that Empire Roofing or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate discharge without recourse.
I understand that an investigative report may be made by a consumer reporting agency to include information as to my character, general reputation, personal characteristics, and mode of living whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such report has been requested, and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
I UNDERSTAND AND AGREE THAT ANY EMPLOYEE HANDBOOK WHICH I MAY RECEIVE WILL NOT CONSTITUTE AN EMPLOYMENT CONTRACT, BUT WILL BE MERELY A GRATUITOUS STATEMENT OF FACILITY POLICIES.
I understand that the facility reserves the right to require its employees to submit to blood tests or urinalyses for alcohol or drug screens, or to allow inspection of bags (including purses or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to a urinalysis, blood test or search, when requested to do so, may result in termination of my employment.
Compliance with this facility's Substance Abuse Policy is a condition of employment. This facility requires that every newly hired employee be free of alcohol or drug abuse. Each offer of employment is contingent upon successfully completing a urinalysis test/screen for alcohol and drugs in accordance with Empire Roofing's policy. Continued employment is also contingent upon compliance with the our Alcohol and Drug Abuse Policy.
I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY EMPIRE ROOFING, MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I, OR THE EMPIRE ROOFING WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE. I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE ADMINISTRATOR OF EMPIRE ROOFING.

Release:

I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize the Registrar/Placement office of all educational institutions attended to release an official copy of my transcript and, if available, faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my licensure status and my licensure history.
Thank you for your interest in Empire Roofing
Please click the "Submit Application" button below when you have finished completing the form.