Custom Tile, Slate, & Metal Roofing

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Chris: (920) 378-4798
Cherie: (920) 378-4800

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Applicant Information
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County
No. of years at this address
Home Telephone
Cell Phone*
Other Telephone
Are you over 18 years of age?*
- Yes
- No
Date of Birth
Date Format: MM slash DD slash YYYY
Position Applying For*
Employment with Company
Have you ever applied for employment with us before?*
- Yes
- No
Have you ever worked with this company or a related company?*
- Yes
- No
If yes, when?
Position held
Position Desired*
Apart from absence for religious observance, are you available for full-time work?*
- Yes
- No
If not, what hours can you work?
What date can you start?*
Date Format: MM slash DD slash YYYY
How did you learn about this position?
Other special training or skills (languages, machine operation, etc.)
Emergency Contact
Emergency Contact Name
Emergency Contact Phone
Relationship
Education
Furthest Education
Name of School
# of Years
Did you graduate?
- Yes
- No
Diploma or Degree
Background
Have you been convicted of a crime in the last 15 years (excluding misdemeanors and sealed/expunged/statutorily eradicated)?*
- No
- Yes
If yes, explain each conviction
Have you served in the Armed Forces?*
- No
- Yes
If yes, when?
Which branch?
Duties performed / specialized training received
Employment History
Begin with most recent. Add up to 3 employers.
Employment History - Employer #1
Company
Telephone
Address
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Name of Supervisor
Weekly Pay Start
Weekly Pay Last
Job Title & Describe Your Work
Reason for Leaving
Operated CDL Equipment?
- Yes
- No
Add More Work (Employer #2)
- Add More Work
Employment History - Employer #2
Company
Telephone
Address
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Name of Supervisor
Weekly Pay Start
Weekly Pay Last
Job Title & Describe Your Work
Reason for Leaving
Operated CDL Equipment?
- Yes
- No
Add More Work (Employer #3)
- Add More Work
Employment History - Employer #3
Company
Telephone
Address
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Name of Supervisor
Weekly Pay Start
Weekly Pay Last
Job Title & Describe Your Work
Reason for Leaving
Operated CDL Equipment?
- Yes
- No
Applicant Questionnaire
Previous Work Experience
Roofing – Flat Roof Work (rubber, hot tar)
- Yes
- No
Roofing – Steep Roof Work (shingles, tile, metal)
- Yes
- No
Roofing – Sheet Metal Work (copper, galvanized)
- Yes
- No
Roofing – Gutter Work / Asbestos removal
- Yes
- No
Carpentry Work – Rough-in/Finish
- Yes
- No
Carpentry Work – Trusses/Roof-sheeting
- Yes
- No
Masonry Work – Tuck-pointing
- Yes
- No
Masonry Work – Flat
- Yes
- No
Masonry Work – Block/Brick
- Yes
- No
Tools/Equipment Worked With
Scaffolding
- Yes
- No
Compressors/Nail Gun/Staple Gun
- Yes
- No
Drills (Standard/Hammer Drill)
- Yes
- No
Ladders (Step/Extension)
- Yes
- No
Saws (Skill saw/Sawzall/Jigsaw/Masons saw)
- Yes
- No
Hand Tools (Snips/Hammer/Chalk Line/Utility Knives)
- Yes
- No
Tape Ruler
- Yes
- No
Vehicles Driven
Flatbed
- Yes
- No
Hours/Miles (Flatbed)
Dump Truck
- Yes
- No
Hours/Miles (Dump Truck)
All Terrain Forklift
- Yes
- No
Hours/Miles (All Terrain Forklift)
Van 1 Ton
- Yes
- No
Hours/Miles (Van 1 Ton)
CDL
- Yes
- No
Hours/Miles (CDL)
Any other qualifications you feel would be useful in this position
Driving Record
Complete if applicable (insurance company checks driving record for past 5 years).
Driver’s License #
State
Driving While Intoxicated (DWI) - Convictions or Pending Charges
Moving Violations / Accidents
Certification & Signature
I certify that the information provided above is true and complete to the best of my knowledge.
Certification*
- I certify that the information provided is true and complete.
Signature (type full name)*
Signature Date*
Date Format: MM slash DD slash YYYY

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At Van De Hey Refined Roofing, we pride ourselves on customer service, efficiency, quality work and an honest price. Our crew is trained on the craftsmanship of hard roof systems including crown roofers for Ludowici and custom copper work.

920.532.4631

4065 Old Car Ct De Pere, WI 54115

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