Application for Employment

An Equal Opportunity Employer – All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

- Step 1 of 8

PERSONAL INFORMATION

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name *

First

Last

Date

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Home Phone

Mobile Phone

Are you eligible to work in the U.S? *

Have you ever been convicted of a felony? *

If yes, please explain *

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) *

Have you ever been terminated from employment or asked to resign by an employer? *

If yes, please provide company names and details

Can you work any shift? *

Can you work overtime, including weekends? *

Can you travel as business needs require? *

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *

EMPLOYMENT DESIRED

Date you can start?

Hourly Rate/Salary desired

Position desired

Are you currently employed? *

May we inquire with your present employer?

REFERRAL SOURCE

How did you hear about us?

Have you ever worked for this company before?

Explain

Do you know anyone who works for our company?

If yes, who?

EDUCATION

HIGH SCHOOL

High School Name & Location

Number of Years Attended

Degree Received

Subjects Studied/Major

COLLEGE OR UNIVERSITY

Name & Location

Number of Years Attended

Degree Received

Subjects Studied/Major

TRADE, BUSINESS OR CORRESPONDENCE SCHOOL

Trade, Business or Correspondence School Name & Location

Number of Years Attended

Degree Received

Subjects Studied/Major

EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Current/Last Job Experience

Start Date

End Date

Employer Name

Employer Phone Number

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Immediate Supervisor & Title

Summarize the Nature of Work Performed and Job Responsibilities

Reason for Leaving

Previous Job Experience

Start Date

End Date

Employer Name

Employer Phone Number

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Immediate Supervisor & Title

Summarize the Nature of Work Performed and Job Responsibilities

Reason for Leaving

Previous Job Experience

Start Date

End Date

Employer Name

Employer Phone Number

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Immediate Supervisor & Title

Summarize the Nature of Work Performed and Job Responsibilities

Reason for Leaving

REFERENCES

Give the names of three persons not related to you, whom you have known at least three (3) years.

REFERENCE ONE

Name

Address, Phone, Email

Company

Years Acquainted

REFERENCE TWO

Name

Address, Phone, Email

Company

Years Acquainted

REFERENCE THREE

Name

Address, Phone, Email

Company

Years Acquainted

Job type you are applying for? *

Authorization to Obtain Motor Vehicle Record

THE UNDERSIGNED DOES HERBY ACKNOWLEDGE AND CERTIY AS FOLLOWS:

Certifies that the undersigned is an employee, or has applied to become an employee of hte below named employer in a position which involves the operation of a motor vehivle an the undersigned gives his or her consent to release of their driving record (MVR) for review by: Superior Insealators *

That the undersigned authorizes his or her driving recored to be periodically obtained and reviewed for the purpose of initial and continued employment. *

That all information in this form is true and correct. The undersigned makes this certification and affirmation under penaltty of perjury and understands that making a false statement or representation on this form is a criminal violation *

Name of Employee/Potential Employee *

License Number *

Issuing State *

Date of Birth *

Signature of Employee/Potential Employee *

PLEASE READ CAREFULLY BEFORE SIGNING

Superior Insealators is an equal opportunity employer. Superior Insealators does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Superior Insealators to hire me. If I am hired, I understand that either Superior Insealators or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Superior Insealators has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Superior Insealators true and complete information on this application. No requested information has been concealed. I authorize Superior Insealators 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 immediate dismissal.

Accept Terms of Submitting Job Application

Yes, I agree
No, I don't agree and my job application will not be accepted

Date / Time *

Signature *

Southern IN: 812-848-2400 | Central IN: 765-635-0023 | KY: 502-266-8868

Application for Employment

PERSONAL INFORMATION

EMPLOYMENT DESIRED

REFERRAL SOURCE

EDUCATION

HIGH SCHOOL

COLLEGE OR UNIVERSITY

TRADE, BUSINESS OR CORRESPONDENCE SCHOOL

EMPLOYMENT HISTORY

REFERENCES

REFERENCE ONE

REFERENCE TWO

REFERENCE THREE

Authorization to Obtain Motor Vehicle Record

PLEASE READ CAREFULLY BEFORE SIGNING

Superior Insealators – Insulation and building envelope experts

More than 70,000 homes and commercial buildings serviced since 1995.

Superior Insealators

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