Use this form to submit an application for employment with Dan Perkins Roofing. We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, marital status, sexual orientation, or any other legally protected status.Position Applying For Desired Salary Range Date Available for Work MM slash DD slash YYYY Name(Required) First Middle Last Phone(Required)Email(Required) Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you 18 years of age or older? Yes No Are you currently employed? Yes No Are you eligible to legally work in the United States?Proof will be required upon employment Yes No Are you currently on “lay-off” status and subject to recall? Yes No Can you travel if a job requires it? Yes No Do you have a valid driver’s license? Yes No Has your driver’s license been revoked or restricted for any reason in the last 5 years? Yes No EducationHigh School Name Did you graduate? Yes No College Name Years Completed Degree Other Education Work HistoryPlease list your work experience beginning with your most recent job held. If you were self-employed, give firm name.I currently work here. 1 I currently work here. Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer PhoneJob Title Address Street Address City State / Province / Region ZIP / Postal Code Supervisor Type of Work Rate of Pay Reason for Leaving Work HistoryI currently work here. 2 I currently work here. Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer PhoneJob Title Address Street Address City State / Province / Region ZIP / Postal Code Supervisor Type of Work Rate of Pay Reason for Leaving Work HistoryI currently work here. 3 I currently work here. Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Employer PhoneJob Title Address Street Address City State / Province / Region ZIP / Postal Code Supervisor Type of Work Rate of Pay Reason for Leaving Do we have permission to contact the employers listed above concerning prior work experience? Yes No Is there a particular employer(s) you do not wish us to contact? QualificationsPlease provide answers to the questions below to help us determine your qualifications;Are you comfortable with climbing ladders and heights? Yes No Are you comfortable being in a harness on a rooftop? Yes No Are you able to lift and carry heavy materials (Over 40 pounds)? Yes No Do you have prior construction experience? Explain.Can you twist, turn, and bend in all standard ways necessary to install building products? Yes No Can you operate a forklift? Yes No Are you familiar with any fall-protection equipment? Yes No Do you have any physical limitations? Yes No My physical restrictions are:Other special skills that we should know about? :(machinery, equipment, computers, office machines, etc.)As part of this application of employment, I hereby authorize Dan Perkins Construction, Inc. to investigate my references and to make an independent investigation of my character, conduct and employment records, and to keep and preserve such records. I agree that failure to reveal any prior employer, or the giving of any false or misleading information by me will be grounds for termination of employment. I understand that this employment application and any other company documents do not constitute a contract of employment and that if hired, I or the company may terminate my employment at any time and for any reason.SignatureEmailThis field is for validation purposes and should be left unchanged.