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New Features
Exceptional
Performance

Fiber-reinforced technology, SECUROCK™ Roof Board, is installed over roof insulation & under membrane, supplying protection, separation, and support.
   Roofing separates people from the elements
and some roofers from all others.

APPLICATION FOR EMPLOYMENT
Pre-Employment Questionnaire
Equal Opportunity Employer

PERSONAL INFORMATION
Name (Last First):SSN:
Present Address: City:State:Zip Code:
Permanent Address:City:State:Zip Code:
Phone No:Referred By:E-Mail:
EMPLOYMENT DESIRED
Position:Date Can Start:Salary Desired:
Are you employed?  Yes   NoIf so, may we inquire of your present employer?  Yes   No
Ever applied to
this company before?
  Yes   No
Where?When?
Name and Location of School
Years
Attended
Did you
Graduate?
Subjects
Studied
Grammar School
High School
College
Trade, Business or
Correspondence
School
ROOFING EXPERIENCE
Years of Roofing Experience:
List Types of Systems Installed:
GENERAL
Subjects of special study/research work
or special training/skills:
US Military or Naval Service:Rank:
FORMER EMPLOYERS
(List below last four employers, starting with last one first)
Date Month and Year
Name and Address of Employer
Salary
Position
Reason
for Leaving
From:       
To:           
From:       
To:           
From:       
To:           
From:       
To:           
REFERENCES
Give below the names of three persons not related to you, whom you have known at least one year.
Name
Address
Business
Years
Known
1.   
2.   
3.   
AUTHORIZATION
 "I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTANDING THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.  
 I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.
 I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FORGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE."

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