Experienced, Licensed, and Insured

1224 Campbell Ave., SE • Roanoke, VA 24013 • Phone (540) 981-9022 • Fax (540) 981-9033

Employment Application

Applications are considered for all positions without regard to race, color, sex, national, age, martial or veteran status, or in the presence of non-related medical condition or handicap.

* = Required fields

What types of projects have you worked on in the past? (Wendy's, Home Depot, Kohl's, etc.) Please list the name and tpye of business (retail, distribution center, restaurant, etc.)
*Name:
*Date:
*Phone #:
Email:
*Address:
*City:
*State:
*Zip Code:
*SS#:
*DOB:
Are you a citizen of the United States of America?	Yes No
Have you applied here before?	Yes No
When?
Position currently appling for?
Start when?
Full-time
Part-time
Tempory
Other
Have you been convicted of a felony?	Yes No
Please explain:
Emergency Contact:
Phone #:
Employment Experience: Start with your present employer or last employer. Include military assignments & other volunteer activities. Exclude organizations names which indicate race, religion, or national origin.
*Present or last employer:
*Address:
*City:
*State:
*Zip:
*Phone #:
*Supervisor's Name:
*Job Title:
*Reason for Leaving:
*Employment Start Date:
*Employment End Date:
*Salary or Hourly Rate:
Job Duties:

Job #2:
Address:
City:
State:
Zip:
Phone #:
Supervisor's Name:
Job Title:
Reason for Leaving:
Employment Start Date:
Employment End Date:
Salary or Hourly Rate:
Job Duties:

Job #3:
Address:
City:
State:
Zip:
Phone #:
Supervisor's Name:
Job Title:
Reason for Leaving:
Employment Start Date:
Employment End Date:
Salary or Hourly Rate:
Job Duties:

Reference 1
Name:
Address:
Phone #:
Years Acquainted:

Reference 2
Name:
Address:
Phone #:
Years Acquainted:

Reference 3
Name:
Address:
Phone #:
Years Acquainted:

Reference 4
Name:
Address:
Phone #:
Years Acquainted:

Education:
Schools/College Attended:
# Years:
Year Grad:
Degree:
Schools/College Attended:
# Years:
Year Grad:
Degree:

Describe any Special qualificatons for this job:
Describe and special certifications or training (safety, OSHA, equipment)
Are you a veteran of the U.S. Military Service?	Yes No
Do you have a valid driver's license?	Yes No
If no, please provide a short explanation why & also when can you get it back?
Drivers License #:
State:
Expiration:
Can you read blueprints?	Yes No
Do you own a tool belt and basic hand tools?	Yes No
If no, are you willing to purchase them?	Yes No
What is your job title with your most recent employer?

How many individuals have you supervised on one project?
Are you experienced at interacting with management and/or clients professionally?	Yes No
If no, Do you believe you possess the skills to do so?
Are you computer literate?	Yes No
Do you own a laptop?	Yes No
Are you capable of uploading and transferring photos and documents?	Yes No
Wiil anything prohibit you from traveling for 1 to 4 weeks at a time?	Yes No
Can you pass pre-employment and/or random drug screens	Yes No
What are your salary requirements

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or during my interview may result in termination.
Yes No