Employment Application | Zablocki Roofing

Applicant Information

Name*

First M.I. Last

Address*

Street Address Apartment/Unit # City State ZIP Code

Phone*

Email*

Date Available*

Desired Salary*

Position Applied for*

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

Yes
No

Have you ever worked for this company?*

Yes
No

If yes, when?

Performance of Essential Job Functions

Do you have a Valid Driver’s License?*

Yes
No

Comments:

Do you have any accidents or moving violations in the past 2 years?*

Yes
No

Comments:

Are you able to perform job-related tasks?*

Yes
No

Comments:

Additional Information

Other Skills

Education

High School

Name	Address	Dates Attended	Did you graduate?	Diploma

College

Name	Address	Dates Attended	Did you graduate?	Diploma

Other

Name	Address	Dates Attended	Did you graduate?	Diploma

References

Please list three professional references.

Reference #1*

Full Name	Relationship	Company	Phone	Address

Reference #2*

Full Name	Relationship	Company	Phone	Address

Reference #3*

Full Name	Relationship	Company	Phone	Address

Previous Employment

Employer #1

Company

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Employer #2

Company

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Employer #3

Company

Phone

Address

Street Address City State ZIP Code

Supervisor

Job Title

Responsibilities

Employed From

Employed To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Disclaimer and Signature

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.

I authorize any of the persons or organizations referenced in this application to give Zablocki Roofing any and all information concerning my previous employment, education or any other information they might have, with regard to any of the subjects covered by this application, and release all such parties from the liability for any damage that may result from furnishing such information. I authorize Zablocki Roofing to request and receive such information.

I understand that if I am offered employment with Zablocki Roofing, it will be on an “at will” basis. This means that either I or Zablocki Roofing may terminate the employment relationship at any time for any reason, with or without cause. I further understand that the “at will” nature of my employment with Zablocki Roofing is an aspect of employment that cannot be modified or changed, except by a written agreement signed by the chief executive officer of Zablocki Roofing, Inc. I understand that nothing contained in the application or conveyed during any interview which may be granted or during my employment (if hired) is intended to create an employment contract between me and Zablocki Roofing, Inc.

Signature of Applicant*

Date*