Roofing Systems

Applicant Note

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. If employment is offered, it is strictly on an "at will" basis, which means that you may resign at any time, or Doliveira Systems LLC may terminate your employment at any time for no reason, or for any reason not prohibited by law. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Affirmative action hiring may be requested by qualified applicants. Additional testing of job related skills and for the presence of drugs on your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Doliveira Systems LLC is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, veteran status, or any other legally protected status.

General Information

Name: (First, Middle, Last)

Alias: (Any Alias Used)

Home Address:

City:

State:

Zipcode:

Previous Address:

City:

State:

Zipcode:

Contact Information:

Home Phone Number:

Work Phone Number:

Emergency Contact:

Email Address:

How Did You Find Doliveria Systems?:

What Languages Can You Speak?

Availability:

Position Applied For:

General Laborer

Hours Requested:

Rate of Pay:

Date Available to Work:

Education:

Highschool Name:

From Year:

To Year:

Graduate?

College Name:

From Year:

To Year:

Graduate?

Graduate Name:

From Year:

To Year:

Graduate?

Other (Specify):

From Year:

To Year:

Certifications?

Employment:

Employer #1

Employer:

Supervisor:

From Year:

To Year:

Position:

Salary:

Responsibilities:

Employer #2

Employer:

Supervisor:

From Year:

To Year:

Position:

Salary:

Responsibilities:

Employer #3

Employer:

Supervisor:

From Year:

To Year:

Position:

Salary:

Responsibilities:

Job Skills:

Driver's' License Number:

State of Issue:

Is Your License Valid:

License Type:

Endorsements:

Restrictions:

Moving Violations:

Other Skills:

Have you been given a job description?

Do you understand the job requirements?

Can you perform the requirements herein?

Security:

List all countries and states of residence of the past seven years:

Have you ever been convicted of a felony and/or served time for a felony within the last 7-years?

Are you a U.S. citizen or are you otherwise authorized to work in the U.S. without restrictions?

References:

Reference #1:

Name:

Address:

Phone:

Relationship:

Reference #2:

Name:

Address:

Phone:

Relationship:

Reference #3:

Name:

Address:

Phone:

Relationship:

Comments:

Certification, Release and ADR

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Doliveira Systems LLC to verify their accuracy and to obtain reference information on my work performance. I hereby release Doliveira Systems LLC from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Doliveira Systems LLC However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at-will and that either I or Doliveira Systems LLC may terminate my employment at any time with or without notice or cause.

Digital Signature:

Signature Date:

Email Address:

	800.311.6072
	800.311.6072
	roof@dsystems1.com
	1237 Penn Avenue, Hollsopple, PA 15935

	800.311.6072
	800.311.6072
	roof@dsystems1.com
	1237 Penn Avenue, Hollsopple, PA 15935

Applicant Note

General Information

Contact Information:

Availability:

Education:

Employment:

Employer #1

Employer #2

Employer #3

Job Skills:

Security:

References:

Reference #1:

Reference #2:

Reference #3:

Certification, Release and ADR

Please bring your social security number with you to the personal interview.

Download additional forms required here:

DOWNLOAD YOUR BLANK W4 FORM

DOWNLOAD YOUR BLANK DIRECT DEPOSIT FORM

DOWNLOAD YOUR BLANK SECURITY BADGE FORM

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