Thank you for considering Dr. Roof as a place of employment. We are always looking for qualified applicants. Please completely fill out the application below. (NOTE: Item numbers in red indicate required fields.) If you have any questions, please visit our Contact Us page.

 

Thank You!

APPLICATION FOR EMPLOYMENT

1.) Today's Date:                                                 

 

2.) Position Requested:       

 

3.) Please list your employment experience in the box below:

 

4.) What day can  you start:                                                 

 

5.) Desired pay rate:  $ per hour.

 

6.) Are you currently employed?       

 

7.) If currently employed, may we contact your employer?       

 

8.) Have you ever applied for work with us before?       

Personal Information

9.) First Name:                Middle Initial:                    Last Name:       

 

10.) Current Street Address:       

 

11.) City:                State:                Zip:       

 

12.) Current email address:    

 

13.) Confirm email address:    

 

14.) Contact telephone number:       (Format: xxx-xxx-xxxx)

 

15.) Confirm telephone number:       (Format: xxx-xxx-xxxx)

 

16.) If you have any other relevant contact information, please list it in the box below:

 

 

17.) Are you 18 years of age or older?       

 

18.) Are you legally allowed to work in the United States?      

 

19.) Do you have a valid, state-recognized drivers license?  

 

20.) Social Security Number:          (Format: xxx-xx-xxxx)

 

21.) If any items above need clarification, please address them here:

Education

High School

 

22.) Name of school:   

 

23.) City of School:                   State of School:  

 

24.) Last year completed:                   Did you graduate?   

Post High School

25.) Do you have any vocational education? Yes  No

          If "Yes" above on Item 25, specify courses taken:

 

26.) Do you have an college education? Yes  No

          If "Yes" above on Item 26, specify major/minors/pertinent courses taken:

27.) Did you graduate from college? Yes  No  Not Yet, but I'm working on it.

Former Employees

(List your last two employers, starting with the most recent one first)

28.) Most Recent Employer Information

Date

Name of Previous Employer

Departing Pay Rate

Position

From:  

 

(Format:

xx/xx/xx)

 

 $ p/hr

 

To:    

 

Phone Number of Most Recent Employer:      (Format: xxx-xxx-xxxx)

 

29.) Previous Employer Information

Date

Name of Previous Employer

Departing Pay Rate

Position

From:  

 

(Format:

xx/xx/xx)

 

 $ p/hr

 

To:  

 

 

Phone Number to Most Recent Employer:      (Format: xxx-xxx-xxxx)

 

References

(List below three persons not related to you whom you have know at least one year.)

30.) References

Name Address Position, if Applicable Years Known
       
       

 

 

 

 

 

Employment Terms and Conditions

  1. If you are to be hired by Dr. Roof Atlanta, Inc. (DRA), you will be required to attest to your identity and employment eligibility, and must provide legal documents as required by the law confirming such identity and employment eligibility. Furthermore, since circumstance may necessitate driving company vehicles from time to time, a copy of a valid drivers licenses will be required. (NOTE: You cannot be hired if you cannot comply with these requirements.)

  2. I hereby certify that the facts contained in this application and any such related documents, such as a résumé, are true and complete to the best of my knowledge. I also understand that any false statement, omission, or misrepresentation on this application or related documents is sufficient cause for refusal to hire and will provide grounds to terminate employment if already employed by DRA no matter when discovered. (NOTE: Termination or refusal to hire are at the sole discretion of DRA.)

  3. I understand that any employment is conditioned on a background check and I therefore authorize DRA to thoroughly investigate all statements contained in my application, résumé, or other applicable documents and I further authorize my former employers and references listed above to disclose information regarding my former employment, character, and general reputation. I authorize such disclosure to be made available to DRA without giving me prior notice. In addition, I release DRA, former employers, and references listed above from any and all claims, demands, or liabilities arising out of or relating to such investigation or disclosures.

  4. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be on an "At Will" basis, meaning it will be without a fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or DRA. No promises regarding employment have been made to me.

  5. If I am offered employment I agree to submit to a medical examination and/or drug test before starting work, if required. If employed I also agree to submit to such examinations and/or tests at any time deemed appropriate during my employment with DRA. Whether such examinations and/or tests are required will be at the sole discretion of DRA as permitted by law. I hereby consent to such examinations and/or tests, and I authorize the release of information obtained by such examinations and/or tests to DRA. I further understand that the results of such examinations and/or tests will remain confidential to the most reasonable extent possible. I understand that my being hired or my continued employment, to the extent permitted by law, is contingent upon satisfactorily passing such examinations and/or tests in accordance to standards established by DRA and those of the applicable law. 

  6. If I am hired a condition of my employment will be that I abide by DRA's drug, alcohol, safety, and procedural rules and policies. (NOTE: DRA retains the right to revise its policies and/or procedures, in whole or in part, at any time.)

  7. I Understand that submitting this form does not indicate there is a position open and does not obligate DRA to respond or hire.

By clicking submit below you are verifying that you have read and understand Items I, II, III, IV, V, VI, and VII above, and hereby agree to the Employment Terms and Conditions as set forth therein.