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141 Wallis St, Eugene, OR 97402
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REQUEST AN ESTIMATE
EMPLOYMENT APPLICATION
Step
1
of
5
20%
Instructions
Please answer all questions fully and accurately. We hire and promote without regard to race, color, sex, national origin, religion, marital status, age, or mental or physical handicap unrelated to job performance.
Today's Date
*
MM slash DD slash YYYY
Position Applied For:
*
Date Available
*
MM slash DD slash YYYY
*
Part Time
Full Time
Temporary
Personal Data
Name
*
First
Middle
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Last 4 of Social Security Number
*
Date of Birth
*
Home Phone
Cell Phone
Are you a citizen of the United States?
*
Yes
No
Are you at least 18 years old?
*
Yes
No
Are you authorized to work in the US?
*
Yes
No
Can you provide proof that you are legally able to work in this country?
*
Yes
No
Have you ever worked for Armadillo Roofing in the past?
*
Yes
No
When?
*
DD slash MM slash YYYY
Do you have a valid driver's license?
*
Yes
No
Drivers License Number
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Education
High School Name
*
Did you Graduate?
*
Yes
No
Degree
*
Highest Grade Completed
*
Please enter a number less than or equal to
12
.
Trade School
School Name
Degree/Certification
College/University
School Name
Did you Graduate?
Yes
No
Degree
Highest Grade Completed
Qualifications and Special Skills
Please list any special skills, qualifications, licenses, or training that may be relevant to this position but is not covered in the above sections.
Please list any special skills, qualifications, licenses, or training that may be relevant to this position but is not covered in the above sections.
Prior Work History
Employer
*
Supervisor
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Position
*
Start Date
*
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
Employer
Supervisor
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
Employer
Supervisor
First
Last
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Position
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
References
Name
*
First
Last
Phone Number
*
Occupation
*
Years Known
*
Please enter a number less than or equal to
99
.
Name
*
First
Last
Phone Number
*
Occupation
*
Years Known
*
Please enter a number less than or equal to
99
.
Name
*
First
Last
Phone Number
*
Occupation
*
Years Known
*
Please enter a number less than or equal to
99
.
EEO Supplemental Information Form
To ensure full legal compliance, Armadillo Roofing invites you to self-identify your race or ethnicity. This section is completely voluntary. Refusal to fill out this form will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance to applicable laws, executive orders, and regulations. When reported, this data will not identify any individual.
This will supply us with information we need for federal reporting obligations. Please be advised that all information provided here is confidential. No information provided here will be used as the basis for any employment decisions. Armadillo Roofing will make every effort to meet a request for disability accommodations.
Gender
Male
Female
Refuse to Identify
What is your race/ethnicity? Please mark one box that you primarily identify with
Asian
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native American or Pacific Islander
White or Caucasian
Refuse to Identify
Affidavit
I certify that, to the best of my knowledge, the information contained in this application is both accurate and complete. I understand that employment may be denied or revoked at any time if information provided here is false, misleading, or incomplete. I understand that, if I am hired, I must produce applicable documents showing that I am lawfully authorized to work in the United States, in accordance with the Immigration Reform and Control Act of 1986, as amended. I understand that current and previous employers, educational institutions, and other references listed or unlisted on this application may be contacted by Armadillo Roofing. These references are authorized to give Armadillo Roofing any and all pertinent information that they may have. I release all persons or entities involved, including Armadillo Roofing, from all liability arising from this contact and provision of information. I agree to conform to all Armadillo Roofing policies, rules, and procedures. Furthermore, I understand and agree that nothing contained in this application, the granting of an interview, or in the offer of employment creates a contract between Armadillo Roofing and myself. If an employment relationship is established, I understand that, in the absence of a formally executed contract to the contrary, you have the right to terminate employment at any time and for any reason. Armadillo Roofing has the same right for any lawful reason.
*
I certify that, to the best of my knowledge, the information contained in this application is both accurate and complete. I understand that employment may be denied or revoked at any time if information provided here is false, misleading, or incomplete.
I understand that, if I am hired, I must produce applicable documents showing that I am lawfully authorized to work in the United States, in accordance with the Immigration Reform and Control Act of 1986, as amended.
I understand that current and previous employers, educational institutions, and other references listed or unlisted on this application may be contacted by Armadillo Roofing. These references are authorized to give Armadillo Roofing any and all pertinent information that they may have. I release all persons or entities involved, including Armadillo Roofing, from all liability arising from this contact and provision of information.
I agree to conform to all Armadillo Roofing policies, rules, and procedures.
Furthermore, I understand and agree that nothing contained in this application, the granting of an interview, or in the offer of employment creates a contract between Armadillo Roofing and myself. If an employment relationship is established, I understand that, in the absence of a formally executed contract to the contrary, you have the right to
terminate employment at any time and for any reason. Armadillo Roofing has the same right for any lawful reason.
I agree.
Signature
First
Last
Date
MM slash DD slash YYYY