Application for Employment

General Background Information

Please fill out all areas (unless marked optional)

Position(s) Applied for:*
Select at least 1 response.

Sales

Estimator

Marketing

Administration

Roofer

Laborer

Crew Leader

Service Leader

Other, please specify

General Information*

Last Name
First Name
Middle Name
Address
City
State
Zip Code
Telephone Number(s)
Email

How did you learn about us? (Optional)

Friend

Walk-In

Internet

Employment Agency

Relative

Job Service

Other

Referred by Current Employee

If you are under 18 years of age, can you provide required proof of you eligibility to work?
Yes No

Have you ever filed an application with us before?*
No
Yes - specify date

Have you ever been employed with us before?*
No
Yes - specify date

Are you currently employed?*
Yes No

May we contact your present employer?*
Yes No

Do you have the legal right to work in the United States?*
(Proof of citizenship or immigration status will be required upon employment.)
Yes No

Are you able to work:*
Full Time Part Time Temp Work

Do you have a valid Driver's License?*
Yes No

Do you have a valid Chauffeur's License?*
Yes No

Do you have a valid Commercial Driver's License?*
Yes No

Driver's license issuing state:

Driver's license number:

Your name as it appears on your driver's license?

Pay expectation: (Optional)

Are you currently on "lay-off" status and subject to recall?*
Yes No

Can you travel if a job requires it?*
One week at a time
5 weeks at a time
Either
Neither

Have you been convicted of a felony within the last 7 years?*
(Conviction will not necessarily disqualify an applicant from employment.)
Yes No

If you answered Yes to the previous question, please explain:

Describe any specialized training, apprenticeships, United States Military Training, skills, and extra-curricular activities.
(Optional)

Summarize special job-related skills and qualifications acquired from employment of other experience.
(Optional)

Education (Optional)

High School

High School Diploma?
Yes
No - specifiy last grade completed

College

College Degree?
No
Yes - specify degree

Career Training

Career Training Degree?
No
Yes - specify degree

Other Education

Other Education Degree?
No
Yes - specify degree

References (Optional)

Reference #1

Name
Occupation
Phone #
Address

Reference #2

Name
Occupation
Phone #
Address

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You should exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer #1

Employer Name:
Supervisor:
Address:
Telephone #(s):
Dates Employed From:
To:
Job Title:
Hourly Rate/Salary:
Work Performed:
Reason for Leaving:

Employer #2

Employer Name:
Supervisor:
Address:
Telephone #(s):
Dates Employed From:
To:
Job Title:
Hourly Rate/Salary:
Work Performed:
Reason for Leaving:

Employer #3

Employer Name:
Supervisor:
Address:
Telephone #(s):
Dates Employed From:
To:
Job Title:
Hourly Rate/Salary:
Work Performed:
Reason for Leaving:

Employer #4

Employer Name:
Supervisor:
Address:
Telephone #(s):
Dates Employed From:
To:
Job Title:
Hourly Rate/Salary:
Work Performed:
Reason for Leaving:

May we contact the employers listed above?*
Yes
No - indicate below which one(s) you do not wish us to contact.

Employers Statement

The Civil Rights Act of 1964 prohibits discrimination on employment because of race, color, religion or national origin. Public Law 90-202 prohibits discrimination because of age. The laws of some states prohibit some or all of the above mentioned types of discrimination.

The Age Discrimination in Employment Act (ADEA) bans discrimination against employees and job applicants who are over 40 years of age, and the Americans with Disabilities Act (ADA) protects disabled persons from discrimination in employment, public services, public accommodations, and telecommunications.

D. C. Taylor Co. is an "at will" employer. This means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such changes are specifically acknowledged in writing by an authorized executive of this organization.

Applicant's Statement

By submitting this application for employment, I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I have been informed that after an offer has been extended to me I must take and pass a Company Physical and Drug Screen to be eligible for employment, as well as completing the Orientation process.

This application for employment shall be considered active for a period of 60 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I agree to the above statement.*
Yes No