Online Employment Application

Date*
PERSONAL INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Social Security Number*
Date of Birth*
Phone*
Cell Phone
Email*
Have you ever worked for Hy-Tech Roofing Services, Inc.?*
- Yes
- No
If yes, when?*
Are you 18 years or older?*
- Yes
- No
If no, do you have a worker's permit?
- Yes
- No
If yes, what type of permit?*
Are you a U.S. Citizen or do you have the legal right to be employed in the U.S.?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentences(s) imposed, and type(s) of rehabilitation.*
MILITARY
Have you ever been in the U.S. Armed Forces?*
- Yes
- No
If yes, what branch?*
Are you currently a member of the National Guard?*
- Yes
- No
Date Entered:
Date Discharged:
Type of Discharge:
Specialty:
EDUCATIONAL DATA
Check highest level completed:*
- 5th
- 6th
- 7th
- 8th
- 9th
- 10th
- 11th
- 12th
- None
List Grammar School(s) and Address(es): List High School(s) and Address(es):
Did you receive a High School Diploma?*
- Yes
- No
Did you receive a Degree from Business or Trade School?
- Yes
- No
Year(s) Completed:
- 1yr
- 2yrs
- 3yrs
- 4yrs
List Business or Trade School Name and Address:
Did you receive a College Degree?
- Yes
- No
Year(s) Completed:
- 1yr
- 2yrs
- 3yrs
- 4yrs
List College Name and Address:
Other: Describe any other specialized or job related training, apprenticeship, skills, extra-curricular activities, training received in the United States military.
LANGUAGE
Indicate any language you can speak, read and/or write along with your fluency in the language.
POSITION DESIRED
Roof or Sheet Metal Position:
- Roofing Mechanic/leader men
- Roof Apprentice
- Roof or Sheet Metal Laborer
- Sheet Metal Mechanic/leader men
- Sheet Metal Apprentice
- CDL Truck Driver
Manager Position:
- Roofing Foreman
- Sheet Metal Foreman
Administrative Position:
- Superintendant
- Estimator/Project Manager
Days/Hours available to work:
Date you can start:
Desired Salary:
Specialized Skills (Complete this section when applying for Office Administration/Estimator /Project Management / Superintendent position)
Typing:
- Yes
- No
Words per Minute:
10 Key Calculator:
- Yes
- No
Mac:
- Yes
- No
Mac Skill Level:
- None
- Basic
- Intermediate
- Advanced
Access Skill Level:
- None
- Basic
- Intermediate
- Advanced
Word Skill Level:
- None
- Basic
- Intermediate
- Advanced
Excel Skill Level:
- None
- Basic
- Intermediate
- Advanced
Power Point Skill Level:
- None
- Basic
- Intermediate
- Advanced
How were you referred to Hy-Tech Roofing Services, Inc.?
- Newspaper
- Sign
- Hy-Tech Website
- Advertisement
- Employment Agency
- Relative
- Hy-Tech Employee
- Walk In
DRIVING HISTORY
Do you presently have a valid drivers license?*
- Yes
- No
State:
License #:
Class of License:
What method of transportation will you use to get to work?
If you presently have a Class E Louisiana Drivers License or you do not have a Drivers License, are you willing to get a Louisiana Drivers License (Class D or Commercial/CDL ) within thirty (30) days of employment?
- Yes
- No
Have you had any accidents during the past 3 years?
- Yes
- No
How many?
Have you had any moving violations during the past 3 years?
- Yes
- No
How many?
Have you ever had license suspension/revocation or citation fro DWI?
- Yes
- No
If yes, when and where?
TWIC
Do you presently have a TWIC (Transportation Worker Identification Credential?*
- Yes (if yes, will need a copy of card)
- No
If no, are you willing to apply for a TWIC card within 30 days of employment?*
- Yes
- No
TRAINING CERTIFICATION
Are you currently NRCA CERTA trained for torch application?
- Yes (if yes, will need a copy of card)
- No
If yes, please give expiration date.
Have you successfully completed ARSC Basic Plus Training within the past year?
- Yes
- No
Date completed:
Are you OSCHA 10 Hr. Certified?
- Yes
- No
Date Certified:
Are you OSCHA 30 Hr. Certified?
- Yes
- No
Date Certified:
Do you presently have any other certification cards? (i.e. Gulf Coast Safety Classes, Industrial Plant, Site Specific, CPR etc.) Please list all certifications (we will need a copy of each at time of hiring):
REFERENCES
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Occupation
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Occupation
EMPLOYMENT HISTORY
Are you currently employed?*
- Yes
- No
If yes, may we contact your present employer?*
- Yes
- No
Current Employer Information: Name of Company:*
Contact Person:
Phone Number:
List former employment starting with most recent (minimum of at least 3)
Employer (most recent)
Address
Street Address City State / Province / Region
Phone:
Supervisor:
Dates Employed (from - to):
Job Duties:
Hourly Rate/Salary:
Reason for Leaving:
Position:
May we contact this employer?
- Yes
- No
Employer (2)
Address
Street Address City State / Province / Region
Phone:
Supervisor:
Dates Employed (from - to):
Job Duties:
Hourly Rate/Salary:
Reason for Leaving:
Position:
May we contact this employer?
- Yes
- No
Employer (3)
Address
Street Address City State
Phone:
Supervisor:
Date Employed ( from - to):
Job Duties:
Hourly Rate/Salary:
Reason for Leaving:
Position:
May we contact this employer?
- Yes
- No
Did you complete the application yourself?
- Yes
- No
If no, who completed?
QUALIFICATIONS AND PHYSICAL DATA:
Qualifications for sheet metal workers, roofers, or laborers include but are not limited to the following: Must have roofing and/ or sheet metal experience; have full range of mobility in upper and lower body; ability to work in various positions, including, but not limited to stooping, standing, bending over, sitting, kneeling , and squatting for extended periods of time; ability to work in direct sunlight and cold for extended periods; ability to work with hot asphalt and torch (open flame) applications; ability to work on rooftops and from ladders in a safe manner; ability to lift ( 90+lbs.), pull , and push material and equipment to complete assigned job tasks; must have basic tools (at time of interview).
Do you have any physical limitations that would prevent you from performing work for which you are being considered?*
- Yes
- No
PLEASE READ CAREFULLY
APPLICATION FORM WAIVER
In exchange for the consideration of my job application by Hy -Tech Roofing Services, Inc. (hereinafter called “the Company”), I agree that: I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact s chools , previous employers (unless otherwise indicated) and others , perform a background check , and herby release the Company from any liability as a result of such contact. I also understand that (1) the Company has a drug and alcohol policy that provides a dr ug free work place as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; (3) continued employment is based on the successful passing of testing under such policy. I further understand that con tinued employment may be based on the successful passing of job- related physical examinations. I further understand that my employment with the Company can be probationary for a period of ninety (90) days, and further that at any time during the probationa ry period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
By entering your name in the space below, you agree to our Application Waiver and attest that the information you provided in this application is correct.*
Date*
HyTech Roofing Services, Inc.
Our company 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 this Company depends solely on your qualifications.
Thank you for completing this application form and for your interest in our Company.

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PERSONAL INFORMATION

MILITARY

EDUCATIONAL DATA

LANGUAGE

POSITION DESIRED

Specialized Skills (Complete this section when applying for Office Administration/Estimator /Project Management / Superintendent position)

DRIVING HISTORY

TWIC

TRAINING CERTIFICATION

REFERENCES

EMPLOYMENT HISTORY

List former employment starting with most recent (minimum of at least 3)

QUALIFICATIONS AND PHYSICAL DATA:

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

HyTech Roofing Services, Inc.