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We are an Equal Opportunity Employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief. or disability that does not prohibit performance of essential job functions.

Your Full Name

Last Name*

First Name*

Middle Name*

Your Present Address

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Your Present Street Address**

Present City*

Your Present State*

Present Zip*

Your Contact Information

Your Email Address*

Phone Number*

Application Information

Position Applied For?

What Location Are You Applying At?*

Provide specific information regarding your name or use of another name that would be needed for us to check your work record.

Do you have any relatives who are presently (or have formerly been) employed by Everlast Roofing, Inc.?

How were you referred to Everlast Roofing, Inc.?

Have you ever been convicted of a felony? If yes, please explain.

Education History

High School Name & Location*

High School - Years Completed*

High School - Diploma*

College Name & Location

College - Years Completed

College - Degree

Technical Training

Technical - Years Completed

Technical - Degree

Other Education?

Current / Most Recent Employer

Company Name*

Position Held*

Dates Employed (Start/ Departure) *

Company Address*

Telephone*

Manager / Supervisor*

Reason For Leaving?*

Full Time or Part Time? Wage or Salary?*

Previous Employer

Company Name*

Position Held*

Dates Employed (Start/ Departure) *

Company Address*

Telephone*

Manager / Supervisor*

Reason For Leaving?*

Full Time or Part Time? Wage or Salary?*

References - Please do not include relatives or former employees.

We will contact all of the employers listed on this application unless you specifically exclude them below. Please list any employers you do NOT want us to contact and your reason for the exclusion.

Please list any employeers that should be excluded and why.

Reference 1 - Full Name, Occupation, Years Known, Phone Number.

Reference 2 - Full Name, Occupation, Years Known, Phone Number.

Reference 3 - Full Name, Occupation, Years Known, Phone Number.

Work Availabilty

When can you begin work?*

Do you have any objection to working overtime?*

If no, can you work overtime without prior notice?*

Can you work on Saturday?*

Can you work on Sunday?*

Can you travel if required by this position?*

Salary/Hourly Rate Requirements

If your application receives favorable consideration, what salary/hourly rate would you require?

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Certification Statement

Everlast Roofing, Inc. reserves the right to maintain your application on file for a maximum of 6 months following submission. Following that time, all personal and confidential Information will be destroyed according to company policy.

I CERTIFY THAT ALL OF THE STATEMENTS MADE BY ME ON THIS APPLICATION FOR EMPLOYMENT WITH EVERLAST ROOFING, INC. ARE TRUE, CORRECT, AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Consent and Agreement

CONSENT TO CONDUCT BACKGROUND INVESTIGATION: As a condition of and for the consideration of this application, I give Everlast Roofing, Inc. permission to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information on this application, as well as interviews with past employers. I further give permission to Everlast Roofing, Inc. to conduct this investigation and to discuss the results of this investigation in connection with my application for employment.

CONSENT TO CONTACT PAST EMPLOYERS: I give permission to Everlast Roofing, Inc. to contact all employers listed in this application (except those specifically excluded) for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with Everlast Roofing, Inc., consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of Everlast Roofing, Inc. I further waive all rights I may have under state law to receive a copy of any written statement provided by any of my former employers to Everlast Roofing, Inc. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this release.

CONSENT TO CONTACT GOVERNMENT AGENCIES: I give permission to any agent, attorney or representative of Everlast Roofing, Inc. to receive a copy of any information obtained in the file of any federal, state or local court, governmental agency, law enforcement agency or Investigator concerning or relating to me. I further consent to the release of such information and waive any right under state law concerning notification of the request for a release of such information. In the event a state law does not provide for prospective employers to have access to information, I hereby delegate Everlast Roofing, Inc. as my agent for receipt of information. I understand that the scope of this investigation will be limited to criminal and/or civil records that relate to my honesty, integrity and/or abilities.

COOPERATION WITH INVESTIGATION: I agree to fully cooperate in Everlast Roofing, lnc.'s background investigation, and to sign any waivers or releases that may be necessary to obtain access to relevant information. In the event that any former employer or federal, state or local governmental agency will not release reference information or criminal history information directly to the employer, I agree to personally request such information to the extent permitted by law.

FALSIFICATION STATEMENT: I understand that any falsification or willful omission of fact made in this application or in connection with any background investigation may be sufficient grounds for rejection of this application, or, if discovered after an offer of employment, for immediate dismissal.

EMPLOYMENT "AT WILL": In consideration of my employment, I agree to conform to the rules and regulations of Everlast Roofing, Inc., and my employment and compensation are "at will" in that they can be terminated with or without cause, and with or without notice, at any time, at the option of either Everlast Roofing, Inc. other than the President of Everlast Roofing, Inc., has authority to enter into any agreement for employment for any specified period of time or to make any agreement or contract to the foregoing, and that any promises to the contrary will only be relied upon by me if they are in writing and signed by the President of Everlast Roofing, Inc.