Section 1- Personal Information Name: Email: Address: City: State: Zip: Phone: Date of Birth: Social Security Number: Drivers License Number and Expiration Date: Section 2- Experience Most Recent Employer and Position: From: To: Reason for Leaving:             Previous Employer and Position: From: To: Reason for Leaving:             Years in Roofing: Residential: Commercial: Most Recent Hourly Wage:               Indicate Systems(s) You Have Installed: Shingles: Yes:       Slate & Tile Yes:       Waterproofing Yes:       Single Ply Yes:       Thermo Plastic Yes:       Asphalt Bur Yes:       Modified Bitumin Yes:       Coal Tar Yes:       Sheet Metal Yes:                 At what system are you best? What are your career goals? Indicate any other skills you have in addition to roofing: Indicate any formal training or seminars you have completed: Have you ever been certified to do asbestos abatement? Yes: No: If no, are you willing to be certified? Yes: No: How many days do you typically work in one week? Section 3- Background Information Highest Grade of School Completed: Do you have a valid drivers license? Yes: No: Do you have a CDL license? Yes: No: Do you currently belong to a union? Yes: No: Union: Classification: Do you have reliable transportation? Yes: No: Have you ever been arrested? Yes: No: If so, please explain: Are you currently unemployed? Yes: No: Are you collecting unemployment compensation? Yes: No: Reason for seeking new employment: Do you consent to drug testing as a pre-condition of employment? Yes: No: Please give the name and phone number of an employer reference: Do you consent to a state police background check as a pre-condition of employment? Yes: No: In the event you are hired, do you agree to comply with every aspect of the Phoenix Roofing, Inc. safety policy? Yes: No:     By typing my electronic signature below, I attest that the information above is true and factual to the best of my knowledge and belief.   Emergency Information: Contact: Relationship: Phone:     Name: Date: