J Stevens Construction - Roofing

Prospective employees will receive consideration without discrimination because of race,
Creed, color, sex, religion, age, national origin, handicap, or marital status, except
where a reasonable bona fide occupation qualification exists.

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Personal Information
Last Name First Middle
Home Address: City: State: ZIP:
Home Phone:
Position applying for: Date available:
Are you over 18 years of age? Yes No	Date of Birth Month Day Year
Schedule Preference Full Time	Salary Expectations
Has J.Stevens Construction ever employed you? Yes No
How were you referred to J.Stevens Construction?

Education
Type of School	Name and Location of School	Degree/Area of Study	# of Years Attended	Degree/Diploma Received?
High School/GED
Business/Trade
College

Legal

Are you a U.S. citizen or do you have a legal right and necessary documents to work in the U.S.?
Yes No
(Identity and employment eligibility of all new hires will be verified as required by the immigration Reform and Control Act of 1986.)

Did any company ever discharge you?
Yes No
If yes, give name of company(ies) and reason for discharge:

Have you ever been convicted of a crime in the past ten years (excluding misdemeanors) which has not been annulled, expunged, or sealed by a court?
Yes No
If yes, describe in full:

The existence of a criminal record does not constitute an automatic bar to employment. It will be considered only as it relates to the job in question.

Previous Employment
Start with your most present or most recent employer.
Employer Name
Address City State Phone
Supervisor Name and Title
Employed from to		Position Held
May we contact? Yes No	Reason for leaving	Hourly Pay
Employer Name
Address City State Phone
Supervisor Name and Title
Employed from to		Position Held
May we contact? Yes No	Reason for leaving	Hourly Pay
Employer Name
Address City State Phone
Supervisor Name and Title
Employed from to		Position Held
May we contact? Yes No	Reason for leaving	Hourly Pay

References
Name	Business	Title	Work Phone	Years Known

Please Read Carefully

The facts set forth in this application are true and complete. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in dismissal. I understand, also, that I am to abide by all the rules and regulations of J. Stevens Construction.

I understand that, with my authorization, an investigation may be made whereby information is obtained my character, previous employment, general reputation, educational background, credit record and/or criminal history.

I understand and agree that if hired, my employment will be “at will”. That is, either J. Stevens Construction or I may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by J. Stevens Construction does not imply employment and that this application and/or employee handbook, manuals, personnel policies are not employment contracts and do not change my status as an “at will” employee.

I agree

Essential Job Functions

J. Stevens Construction employees are required to be able to work several positions. Each position requires different essential job functions to be completed. The positions you must be able to perform to standard are: Please take a moment to read the following list of essential job functions:

Must be able to see sufficiently to maintain safety and determine product quality, service, and cleanliness.
Must have mobility to get the up and down the roof. Also moving across the roof.
Must be able to withstand 90+ degrees heat in the summer and below freezing in the winter.
Must be able to follow directions and communicate with the crew and management team.
Vertical extension of one or both arms up to 100%
Horizontal extension of one or both arms up to 100%
Bending of one or both arms up to 100%
Gripping and holding with one or both arms up to 100%
Bending of the back up to 180 degrees from vertical
Twisting of the back up to 90 degrees left and right
Lifting up to 40 pounds
Pushing and pulling up to 40 pounds
Must be able to work 40+ hours
Must be able to do toolbox safety talks every week
Must be able to communicate with others

Have you had any medical problems in the last ten years?
Yes No
If yes, describe in full:

After having read the above list, please feel free to discuss any concerns or possible accommodations you may need with your interviewer. In accordance with the ADA, certain provisions may be made. Our intent is to provide you with a safe and fulfilling work experience, and your help is greatly appreciated.

I have read the above list functions and motions, and I am able to satisfy each of them.