330-837-1999

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Employment Application

Please complete the employment application below. Fields marked with an "*" are required.

Personal Information

First Name *
Last Name *
Phone Number *
Cellphone
Email Address *
Address
City
State
ZIP Code
If you have lived at your current address less than 1 year please submit previous address.
Address
City
State
ZIP Code
Are you a U.S. citizen or an authorized alien to work in the United States?
Yes No
Do you have a valid license?
Yes No
Do you have valid insurance?
Yes No
What position are you applying for?
If Roofer what experience?

Military Service & Criminal Background

Branch of Service
Rank
Discharge Date
Present membership in National Guard or Reserves
Date Obligation Ends
Have you been convicted of a felony or misdemeanor in past 5 years?
Yes No
If yes please describe.

Education

Name of High School
Did you Graduate?
Yes No
Name of College
Did you Graduate?
Yes No
Other Schooling
Did you Graduate?
Yes No

Equal Opportunity Employment Information

The information supplied below is strictly voluntary and will in no way affect the processing of your employment status with this company. This information will only be used for statistical purposes. Thank you for your cooperation.
Gender
Race
Are you an individual with physical or mental impairment which substantially limits one or more of your major life activities?
Yes No
Are you a veteran?
Yes No
Status

Work Experience

Name of Company
From
To
List of Duties
Starting Salary
Ending Salary
Reason for Leaving
Name of Company
From
To
List of Duties
Starting Salary
Ending Salary
Reason for Leaving
Name of Company
From
To
List of Duties
Starting Salary
Ending Salary
Reason for Leaving

References

Full Name
Address
Phone
Full Name
Address
Phone
Full Name
Address
Phone

Signature

By submitting your digital signature you are stating that all information you are providing is true and correct. You are also aware that if your license or insurance status change at any time you must inform the office immediately.
Full Name *

* The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age, or by other means. The term "employment applications," refers to all written inquires about employment or applications for employment or promotion, including, but not limited to, resumes or other summaries of the applicant's background. It relates not only to written preemployment inquires, but to inquires by employees concerning terms, conditions, or privileges of employment as specified in section 4 of the act.

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Advanced Industrial Roofing, Inc.
1330 Erie St S
Massillon, OH 44646
330-837-1999

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