Employment Application

Employment History
Provide the following information of your past two (2) employers, assignments or volunteer activities, starting with the most recent.
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Employer
Phone
Starting Job Title/Final Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
May we contact for reference
- Yes
- No
- Later
Reason for leaving
Hourly Rate/Salary
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY
Employer
Phone
Starting Job Title/Final Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
May we contact for reference
- Yes
- No
- Later
Reason for leaving
Hourly Rate/Salary

Skills and Qualifications
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background
Job Related
Name and Location
Number of Years Completed
Did you Graduate?
Course of Study

References
Name
First Last
Phone
Years Known
Name
First Last
Phone
Years Known
Name
First Last
Phone
Years Known

Resume
Document Uploader
Accepted file types: pdf, doc, docx.
Please upload your resume as a PDF or Word Document.
Application Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 6 months. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or define duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United states and that federal immigration laws require me to complete an I-9 Form in this regard.
Union Roofer?
- Yes
- No
Number of Years - Journeyman
Number of Years - Apprentice
Do you have a CDL?
- Yes
- No
License Number
Have you completed the OSHA 10 hour course?
- Yes
- No
Date of Completion
Date Format: MM slash DD slash YYYY
Location of Completion
Do you have a valid BCRC card?
- Yes
- No
Card Number
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

NOTE: Please click SUBMIT only ONCE, and allow 15-30 seconds before leaving page if you see a spinning wheel indicating the processing of your application submission.

Sorry for any inconvenience. Thank you!
Signature
Date
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Employment Application

Step 1 of 5 - Personal Information

Employment History

Skills and Qualifications

Educational Background

References

Resume

Application Statement