Application for Employment

Date *
Name *
(Street, Route, and Apartment Number)
(City, State, and Zip Code)
Home Phone *
Home Phone
Other Phone
Other Phone
(Select One)
Are you at least 18-years of age? *
Do you have the legal right to work or be employed in the United States? *
If yes, as a condition of employment, you are required to submit proof of employment eligibility and identity in compliance with the Immigration Reform and Control Act of 1986.
Have you been convicted of any crime other than a minor traffic offense within the last five years? *
(Name and Address of School)
Did you graduate high school?
(Name and Address of School)
Did you graduate from College?
(Name and Address of School)
Did you graduate from trade, technical, or other schooling?
Are you currently employed? *
Can we contact your current or most recent employer? *
If yes, please provide contact number
If yes, please provide contact number
(Not Former Employers or Relatives)
Reference No. 1 - Phone Number *
Reference No. 1 - Phone Number
Reference No. 2 - Phone Number *
Reference No. 2 - Phone Number
Were you in the U.S. Armed Forces? *
(Select one from the list below)
Beginning date of duty
Beginning date of duty
Ending date of duty
Ending date of duty
Please select below if applicable
I am a member of...
Would you like to work Full-Time or Part-Time? *
(Please select option below)
(Please enter the dollar amount of your desired salary below)
What date are you available for work? *
What date are you available for work?
How did you hear about Merrick-Kemper? *
If you've heard about Merrick-Kemper through an employee referral, please provide the name of said Merrick-Kemper employee. If you've selected "Other" please provide further details here
Do you have any friends or relatives in our employment?
Have you previously worked for Merrick-Kemper? *
Can you travel for work, if required?
Do you have experience in the Sheet Metal and/or Roofing Industry? *
Please include types of sheet metal and roofing experience including familiar materials, and skill set (welding, soldering, roof laying, etc.)
(Please read carefully and click boxes below to verify that you have read and understood the following items in this section)
1. Equal Employment Opportunity - Merrick-Kemper is an equal opportunity employer. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, physical or mental disability or veteran status. This policy of nondiscrimination extends to all terms, conditions and privileges of employment and to all personnel actions. *
2. Authorization by Applicant - I authorize Merrick-Kemper to contact my former employers and references listed on this application, and I authorize such individuals and organizations to release information required by Merrick-Kemper. The information supplied on this application and by way of any oral statements is true and accurate, and I understand that any misstatement by me may result in immediate dismissal. I release all parties from all liability for any damage that may result from furnishing same to you. *
3. Employment at Will - I agree to conform to the rules and regulations of Merrick-Kemper upon my acceptance of employment. I understand that my acceptance of employment does not constitute an employment contract and that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the company or myself; and that I will be entitled only to wages or salary earned through the date of such termination. I understand that no manager, supervisor or other representative of management, other than the president or vice president, has the authority to enter into an employment contract, and that any such employment contract must be in writing and signed by the employee and by the president or vice president of the company. *
4. Effective Period - This application is current for thirty (30) days. At the conclusion of which time, if you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application *
5. Application Information Accuracy - By checking the box below you are certifying that the information which you have provided in this application is truthful and accurate, to the best of your knowledge and understanding. *
Please enter today's date *
Please enter today's date

Information provided in an application is confidential between the applicant and Merrick-Kemper.