Academy Roofing -  Application for Employment
Pre-employment Questionnaire  - An Equal Opportunity Employer   
Date of Application __________________
Personal Information 
Name (last name first)	Social Security Number
(optional) 	
		
Present Address                                                	City                         State         Zip Code	
		
Permanent Address                                            	City                        State         Zip Code	
		
Phone Number                                                     	Referred By	

Education History
	SCHOOL NAME AND LOCATION	YEARS ATTENDED	GRADUATE
(Yes or No)	SUBJECTS STUDIED	
Grammar School					
High School					
College					
Trade, OJT, or other?					

General Information
Subjects of Special Study, Research Work or Special Training/Skills		

US Military or Other Service	Rank	

Former Employers (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH THE LAST ONE FIRST)
DATE 
MONTH & YEAR	NAME AND ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING	
FROM
TO					
FROM
TO					
FROM
TO					
FROM
TO					

References (GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)
NAME	ADDRESS	BUSINESS	YEARS KNOWN	

				

Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that they may have personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

DATE ______________   SIGNATURE ______________________________________

INTERVIEWED BY ___________________________ ____DATE _________________

****************************** DO NOT WRITE BELOW THIS LINE **********************************

Remarks

	

	

NEATNESS		CHARACTER			
					
PERSONALTY		ABILITY			
					
HIRED	FOR DEPT	POSITION	WILL REPORT	SALARY WAGES	

APPROVALS:
1 _____________________    2 _____________________  3 __________________________
EMPLOYMENT MANAGER       DEPARTMENT HEAD                 GENERAL MANAGER