JD Roofing & Construction, Inc.

* APPLICATION FOR EMPLYMENT*

Please Complete All Pages
Date of Birth: / /
Date: / /
Name:
----------------------Last---------------------------------------First----------------------------------------Middle-------------Present Address
-----------------------------Number-----------------------Street----------------------City----------State---------Zip Code
Time at current address
Social Security Number
Cell Phone:
Current Email Address:
*HAVE YOU EVER BEEN CONVICTED OF A FELONY*

YES [X] NO [X]

Are you able to work Full Time?

YES [x] NO [X]

Position Applied For _________________________

Desired Hourly Wage ________________________
Are you able to work between the times listed below?
8:00 a.m. to 4:30 p.m. M-F [X]
9:00 a.m. to 5:30 p.m. M-F [X]
10:00 a.m. to 6:30 p.m. M-F [X]
Are you able to work past quitting time to complete a job when necessary?
YES [X] NO [X]
Are you able to work weekends when necessary?
YES [X] NO [X]
Rate your communication skills on a level 1-10

________

Education
Type of School
High School
College
Trade School

Name of School

Location of school

Number of years

Major & Degree

JD Roofing & Construction, Inc.

* APPLICATION FOR EMPLYMENT*
Please Complete All Pages
*DO YOU HAVE A VALID DRIVERS LICENSE*

YES [X] NO [X]

What is your means of transportation to and from work? ______________________________________

Do you have a clean driving record, if not see questions below

YES [X] NO [X]

*DISREGARD THE NEXT TWO QUESTIONS IF YOU HAVE A CLEAN DRIVING RECORD*
Have you had any accidents in the last three years?

YES [X] NO [X]

Have you had any moving violations in the last three years?

YES [X] NO [X]

*If you were not in the military you can skip the next part that is highlighted*
MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES

YES [X] NO [X]

If so what branch of the military were you in?

Specialty:

Date enlisted:

Discharge Date:

]
/

Work Experience: Please list your work experience for the past five years beginning with your most
recent job held. If you were self-employed, give the firm name.
Name of Employer:
Address:
Phone Number:
Employment Dates:
Your last job title:
Reasons for leaving (be specific):

Name of last supervisor:

Pay or Salary: Start $

End $

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company

JD Roofing & Construction, Inc.

* APPLICATION FOR EMPLYMENT*
Name of Employer:
Address:
Phone Number:
Employment Dates:
Your last job title:
Reasons for leaving (be specific):

Name of last supervisor:

Pay or Salary: Start $

End $

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company

Name of Employer:
Address:
Phone Number:
Employment Dates:
Your last job title:
Reasons for leaving (be specific):

Name of last supervisor:

Pay or Salary: Start $

End $

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you
worked at this company

JD Roofing & Construction, Inc.

* APPLICATION FOR EMPLYMENT*

Use the designated space below to summarize any additional information necessary to describe your full
qualifications for the specific position in which you are applying for

May we contact your present employer?

YES [X] NO [X]

Did you complete this application yourself?

YES [X] NO [X]

If not, who did? ________________________________________________________________________

JD Roofing & Construction, Inc.

* APPLICATION FOR EMPLYMENT*
AGREEMENT (PLEASE READ CAREDULLY BEFORE YOU SIGN)
I certify that all the information on this application is accurate and complete to the best of my knowledge
and understand that misleading or false statement will constitute sufficient cause for refusal of the hire
or termination of my employment.
I understand that neither the acceptance of this application nor the subsequent entry into any type of
employment relationship with JD Roofing & Construction, Inc. creates an actual or implied contract of
employment. I understand that, if I accept employment with JD Roofing & Construction, Inc., It will be on
an at-will basis. This means that either JD Roofing & Construction, Inc. or I have the right to terminate the
employment relationship at any time, for any reason, with or without cause.
I agree to submit to drug and alcohol testing, if requested by JD Roofing & Construction, Inc., and its
employees, plus other persons or companies, from any and all liability arising out of or related in any way
to such testing.
I authorize JD Roofing & Construction, Inc. to investigate information concerning my education,
employment experiences and all other aspects of my background relevant to my proposed employment.
I release JD Roofing & Construction, Inc. and its employees from all liability arising from such investigation.

Print Name: ________________________________________________ Date: _____________________

Signature of applicant ________________________________________ Date: _____________________

JD Roofing & Construction, Inc. is an equal opportunity employer. We adhere to a policy of

making employment decisions without regard to race, color, religion, sex, sexual orientation,
national origin, citizenship, age or disability. We assure you that your opportunity for
employment with JD Roofing & Construction, Inc. depends solely on your qualifications.