First Name

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Telephone

E-mail

D.O.B.

Emergency Contact

BACKGROUND INFORMATION

Educational Background

Please check only one option from each question:

Do you consider yourself reliable, dependable, and eager to learn? Yes No

If not then why:

Do you work well with others? Yes No

If not then why:

Do you have a valid drivers license? Yes No

If you do not have a drivers license then do you have a reliable form of transportation to and from work? Yes No

Do you have any roofing experience? Yes No

If so then please describe:

Please describe any other work experience:

What hourly wage are you looking to start?

Please list three references:

NOTICE TO APPLICANT:  The Pawcatuck Roofing Company is an equal opportunity employer.  We insist that all our employees comply with our own safety policy as well as all state and federal Occupational Safety Health Act safety regulations at all times.  We have a zero tolerance drug policy.  Any employee found to be under the influence of drugs or alcohol on Pawcatuck Roofing Co. property or job sites will be subject to immediate termination.  We insist all our employees be safe, dependable, and quality conscious.