Careers Employment Application Date Name Address City/State Zip Date of Birth Home Phone Cell Phone Email Position Applied for: Salary Desired How did you hear about us? Hours Available to Work: Mon Tues Wed Thurs Fri Sat Sun Full timePart timeFull time or part time When Available to begin work? Education Type of School Name of School and Complete Mailing Address No. Years Completed Major or Degree High school College Bus or Trade School Professional School Other Do you have drivers license? YesNo State of issue: License Number: Expiration Date: Have you had any accidents in the past 3 years? YesNo How many? Have you had any moving violations in the past 3 years? YesNo How many? Previous Employment (List up to 3) 1. Name of employer Name of last supervisor From: To: Salary Reason for Leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you work at this company May we contact your employer? YesNo 2. Name of employer Name of last supervisor From: To: Salary Reason for Leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you work at this company May we contact your employer? YesNo 3. Name of employer Name of last supervisor From: To: Salary Reason for Leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you work at this company May we contact your employer? YesNo Certifications/Registrations/Licenses Certificate/License Issuing Authority State License Number Expiration Please list 2 reference other than relatives and previous employers Name Position Company Telephone Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying: Emergency Contact Contact phone: Certification Please Read Carefully Before Signing, Please Ask For Assistance If You Have Questions Correct And Complete Information: To the best of my knowledge, the information I have provided and the statements I have made in this application are correct and complete. I understand that providing false information in this application will result in a refusal to hire, or if hired, a termination of employment. Interview: I understand that submitting an application is not a guarantee of an interview. At-Will Employment: I understand that if I am hired, I will be employed on an "at will" basis. I understand that I will have the right to resign my employment at any time and for any reason, and Sully-Jones Roofing Company (Sully-Jones)may terminate my employment at any time and for any reason, with or without cause. I also understand that although the other policies of Sully-Jones may be changed from time to time, this at-will policy will and does constitute the complete agreement between me and Sully-Jones on the subject of termination superseding all other understandings or agreements, whether express or implied. Data Provision: If I am employed, I will provide additional data as required for reporting purposes. A copy of this data is available upon request. Company Rules And Regulations: I understand that if accepted for employment, I agree to abide by Sully-Jones rules and policies. Substance Abuse Policy: Sully-Jones is a Drug Free Workplace. All applicants who are offered employment must successfully complete a pre-employment drug test as a condition of employment. I hereby agree to submit to substance abuse testing, should I refuse a request, or tamper with a specimen, I will be ineligible for employment with Sully-Jones. Pre-Employment Screening: I understand that employment is contingent upon satisfactory verification of prior employment, my ability to pass a drug screen and my ability to provide accurate and complete past work history. I understand that a background check may be required prior to beginning employment with Sully-Jones. This information may be obtained from a consumer reporting agency for employment purposes. These reports may be obtained at anytime after receipt of your authorization. I authorize Sully-Jones to investigate all statement contained herein, I further authorize the company to contact the employers and references, if any listed, and permit them to give Sully-Jones any and all information concerning my previous employment and any pertinent information they may have concerning my qualifications for employment with the company. I hereby release Sully-Jones, and the persons or entities providing such information from any and all liability for damages that may result from disclosure and/or use of such information. This application when completed and signed becomes the property of Sully-Jones Contractors, Inc. 76225
