Application for Employment

This company is an equal employment opportunity employer. All applications will be considered without regard to age, color, national origin, religion, disability, sex, or other protected status in accordance with applicable federal and state equal employment opportunity laws. This company will strive to accommodate any physical or mental limitations of employees or applicants in order to accomplish the essential functions of a job.

Fields marked with an * are required.

Personal Information

A conviction record will not necessarily be a bar to employment. This information will be considered for job-related purposes and only to the extent permitted by applicable law.


Special Skills, Qualifications and Considerations

Summarize job-related skills and qualifications, volunteer activities, professional, trade, business or civic activities and offices held, military experience, employment and other activities related to the job you are seeking.
You may exclude memberships, which would reveal sex, race, religion, national origin, age, ancestry, or
disability or other protected status:


List three (3) non-relatives who are familiar with your qualifications and actual work history and ability.

Reference 1:

Reference 2:

Reference 3:

Employment Experience

(Start with your present or most recent job)

Employer 1:

Employer 2:

Employer 3:

Reason for leaving?  *

Emergency Contact:

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application, to include but not be limited to work history and social security number verification, criminal background history, for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days, and shall remain on file for one year.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I also understand that no representative of The Company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I agree that The Company reserves the right to require me to submit to a drug/alcohol test prior to employment and at any time during my employment, to the extent permitted by law. I also understand that if I should receive a conditional offer of employment I may be required to submit to a medical examination or medical inquiries to determine my ability to perform the essential functions of the job for which I have applied.

Type your legal name as your digital signature


Rocco Building Supplies, LLC is a drug-free and alcohol-free workplace.

In order to provide our employees with a safe work environment, all employment offers are contingent upon satisfactory results from a preemployment screening. In addition, the Company may require drug and/or alcohol tests to be administered to active employees randomly, for just cause or on a post-accident basis.

Confidential - Edition 6/14/16