Federal, State and local laws and regulations prohibit discrimination on the basis of race, color, religion, creed , national origin, ancestry, sex, disability or medical condition, marital status, veteran status and age. The information on this Application is not solicited for, not shall it be used for the purpose of unlawful discrimination. Simon Roofing and Sheet Metal Corp. is an Equal Opportunity / Affirmative Action Employer.



Personal Information

I understand that I need to check my email regularly during the application process. *
Yes

Driving Information

Have you ever been convicted or plead guilty to a crime?
YesNo

Are you a United States Citizen, National of the US, Alien lawfully admitted for permanent residence or an Alien authorized to be hired for the job for which you are applying? *
YesNo

Are you at least 18 years of age? *
YesNo

What are your career aspirations?

I am applying for this position: *

Have you previously applied to or been employed by Simon Roofing and Sheet Metal Corp?

If yes, please list the date(s) of application or employment, branch locations and position:

Employment History

Briefly describe your duties and responsibilities:

May we contact this employer?
YesNo

Education Background

Diploma or GED*
YesNo

Degree*
YesNo

Diploma/Certification*
YesNo

General Information

Signature

I certify the information I have provided in this Employment Application is true and complete to the best of my knowledge. I understand that, if hired, discovery of any false information provided or any relevant information omitted (no matter when discovered) may result in the immediate termination of my employment. I authorize Simon Roofing and Sheet Metal Corp. (the "Company") to make whatever inquiries it deems necessary or appropriate of any person or organization to verify any of the information I have provided in this application and to determine my qualifications and abilities. I hereby release the Company from any and all claims or action or causes of action arising out of the Company's lawful inquiries and/or its determination of my qualifications and abilities.

Background Investigation and Motor Vehicle Report:

I understand that as part of the Company's procedure for processing employment applications, an investigation and/or report may be made by a consumer reporting agency, and/or other agencies, in the process of which information may be obtained through consumer credit databases and/or interviews with third parties including, but not limited to, past or present employers, learning institutions, law enforcement and all other federal, state and local agencies, military, credit bureaus, family members, business associates, friends, neighbors or others with whom I am or have been acquainted. These inquiries may include, without limitation, information as to my character, general reputation, personal characteristics, employment history, education, criminal record, credit history, driving record and mode of living, and/or review of any public records whichever may be applicable. If the position I am applying for includes driving a company owned, rented or leased vehicle, or driving my own vehicle for company purposes, a motor vehicle report will be obtained prior to employment and during my employment from time to time. I hereby authorize the Company to have such investigations and/or reports made at this time and at any time during my employment for job related purposes. I understand that the Company may rely on this authorization to order additional reports or make additional investigations at any time during my employment without asking me for my authorization again as allowed by law. The Company will use this information for employment and/or insurance purposes only and will not furnish this information to a third party without my written consent. This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., "Federal Drivers Privacy Protection Act," and is intended to constitute "written consent" as required by this Act. A summary of your rights under the Fair Credit Reporting Act, as well as specific State Law Notices for California, Maine, Maryland, Massachusetts, New Jersey, Minnesota, New York, Oregon, and Washington will also be provided to you.

Drug Testing and/or Physical Examination:

Any offer of employment may be conditioned upon my completion of a drug test and/or physical examination which demonstrates that I am capable of performing the essential functions of the position for which I am applying. I hereby consent to undergo a drug screening and/or physical examination which may include any and all tests and procedures determined by the Company to be helpful in evaluation of my suitability for employment, including but not limited to urinalysis, clinical examinations, blood tests, and x-rays. I understand I may be drug and/or alcohol tested at any time during the course of my employment. If I refuse to complete a drug or alcohol test as requested by the Company, I understand that my refusal will be treated as a positive result. If I test positive on any drug and/or alcohol evaluation, I understand that I will be subject to the procedures and/or disciplinary measures as outlined in the Company's Drug and Alcohol Policy, as may be amended from time to time.

I have the right to make a written request within a reasonable period for a complete and accurate disclosure by the Company of the nature and scope of the investigation requested. I understand that if an offer of employment is made to me, it may be conditional upon: 1) the results of the investigations, tests, examinations and reports above authorized; and 2) successful completion of the Company's Safety Training Program, if applicable to the position for which I am applying. The Company may, within its discretion, withdraw its conditional offer of employment based upon the results of an examination and/or investigation. I understand that employment with the Company is "at will" and continues only as long as the employee and the Company both wish to continue. I understand that, if I am hired by the Company, either I or the Company may terminate my employment at any time for any reason. Any modification of this arrangement must be signed by me and an authorized representative of the Company. I agree to release the Company, its employees and those who supplied the information from any liability for any damage which may result from furnishing the requested information or my failure to be hired for the position for which I am applying.

-or -

I have read, understand and agree to the above. My signature below indicates this.*


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