ServMaintRequestFreeQuote-2-min (1)

Applicant Information

Full Name:*

Address:*

Phone:*

Email:*

How did you hear about us?*

Your Variant

Education

High School:

Address:

Did you graduate?

Yes

No

Degree:

College:

Address

From

To

Did you graduate?

Yes

No

Degree:

Other:

Address

From

To

Did you graduate?

Yes

No

Degree:

References

Please list three professional references

Full Name:*

Relationship:*

Company:*

Phone:*

Address:*

Full Name:*

Relationship:*

Company:*

Phone:*

Address:*

Full Name:*

Relationship:*

Company:*

Phone:*

Address:*

Previous Employment

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From

To

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From

To

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From

To

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

No

Military Service

Branch:

From

To

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I understand that neither the completion of this application nor any other part of the application process establishes any obligation on the part of Mid South Roof Systems to employ me. In the event I am hired, it will be on at Will Basis, and I understand that either I or Mid South Roof Systems can terminate the employment at any time and for any reason, with or without cause and without prior notice.

I attest with my signature below that I have given to Mid South Roof Systems true and complete information on this application. No requested information has been concealed. I authorize Mid South Roof Systems to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or if it is applicable immediate dismissal.

It is the policy of Mid South Roof Systems to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, marital status, status with regard to public assistance, status as a disabled, recently separated or other covered veteran, or any other characteristic protected by federal, state, or local law. In addition, Mid South Roof Systems will provide reasonable accommodations for qualified individuals with disabilities.

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ENTERED BELOW.

Date*

I agree to the terms stated above and that the information I have provided is accurate.*

I agree

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Applicant Information

Applicant Information

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer and Signature