Section 1- Personal Information
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:
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: