Date *

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DD

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Name *

First Name

Last Name

Home Phone *

(###)

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Other Phone

(###)

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Are you at least 18-years of age? *

Yes

No

Do you have the legal right to work or be employed in the United States? *

If yes, as a condition of employment, you are required to submit proof of employment eligibility and identity in compliance with the Immigration Reform and Control Act of 1986.

Yes

No

Have you been convicted of any crime other than a minor traffic offense within the last five years? *

Yes

No

Did you graduate high school?

Yes

No

Did you graduate from trade, technical, or other schooling?

Yes

No

Are you currently employed? *

Yes

No

Can we contact your current or most recent employer? *

Yes

No

If yes, please provide contact number

(###)

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Reference No. 1 - Phone Number *

(###)

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Reference No. 2 - Phone Number *

(###)

###

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Were you in the U.S. Armed Forces? *

Yes

No

Beginning date of duty

MM

DD

YYYY

Ending date of duty

MM

DD

YYYY

Please select below if applicable

I am a member of...

The National Guard

The Reserve

Would you like to work Full-Time or Part-Time? *

(Please select option below)

Full-Time Work

Part-Time Work

No Preference

What date are you available for work? *

MM

DD

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How did you hear about Merrick-Kemper? *

Google Ads

Instagram

Facebook

Road Side Advertisement

Internet Search

Referred by a Friend

Referred by Merrick-Kemper Employee (please provide employee name in box below)

Other (please provide details in box below)

Do you have any friends or relatives in our employment?

Yes

No

Have you previously worked for Merrick-Kemper? *

Yes

No

Can you travel for work, if required?

Yes

No

Do you have experience in the Sheet Metal and/or Roofing Industry? *

Yes

No

1. Equal Employment Opportunity - Merrick-Kemper is an equal opportunity employer. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, physical or mental disability or veteran status. This policy of nondiscrimination extends to all terms, conditions and privileges of employment and to all personnel actions. *

Acknowledged

2. Authorization by Applicant - I authorize Merrick-Kemper to contact my former employers and references listed on this application, and I authorize such individuals and organizations to release information required by Merrick-Kemper. The information supplied on this application and by way of any oral statements is true and accurate, and I understand that any misstatement by me may result in immediate dismissal. I release all parties from all liability for any damage that may result from furnishing same to you. *

Acknowledged

3. Employment at Will - I agree to conform to the rules and regulations of Merrick-Kemper upon my acceptance of employment. I understand that my acceptance of employment does not constitute an employment contract and that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself; and that I will be entitled only to wages or salary earned through the date of such termination. I understand that no manager, supervisor or other representative of management, other than the president or vice president, has the authority to enter into an employment contract, and that any such employment contract must be in writing and signed by the employee and by the president or vice president of the company. *

Acknowledged

4. Effective Period - This application is current for thirty (30) days. At the conclusion of which time, if you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application *

Acknowledged

5. Application Information Accuracy - By checking the box below you are certifying that the information which you have provided in this application is truthful and accurate, to the best of your knowledge and understanding. *

Acknowledged

Please enter today's date *

MM

DD

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