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Applicant Certification

I certify by entering my name and today's date below, that all information given on this application is true, correct, and complete to the best of my knowledge. I understand that misrepresentation or omission of facts will be cause for cancellation of my consideration for employment, or dismissal if employed. I authorize any inquiry to be made on my information contained in this application if I am considered for employment. I understand that this is an application for employment and that no employment contractor formal employment offer is being made. I understand that if employed, such employment is for an indefinite period and is subject to change in wages, benefits, and operating policies. I further understand that an offer of employment will be conditioned upon successful completion of a physical examination including a drug test and that continued employment will be subject to the terms of the company’s drug and alcohol policy.

Consent to Background and Reference Check

I, certify by entering my name, address and today's date below hereby authorizes Willoughby Roofing & Sheet Metal, Inc. (the "Company") of 111 2nd Avenue NE Cullman, AL 35055 and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. An electronic, telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. I hereby consent to the Company's verification of all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copies of records pertaining to this information. I also hereby authorize the Company's access to any medical histories or records pertaining to me (and any other individuals who due to my employment may be covered by any Company medical or other insurance program). With regard to the foregoing disclosures, I hereby agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed.

Background Check: Authorization and Release of DMV Records

I, certify by entering my name, dob, license number, state of issuer, and today's date below hereby authorizes Willoughby Roofing & Sheet Metal, Inc. (the "Company") of 111 2nd Avenue NE Cullman, AL 35055 and/or its agents Authorization to check my driving record and release the information found on my DMV Records. I understand that driving a Company vehicle (or my own vehicle, as required) is a requirement of the position I am being considered for and that having and maintaining a satisfactory driving record is a condition of my employment. I agree to allow Willoughby Roofing & Sheet Metal, Inc., or their Insurer to check my driving record prior to hire and to check it periodically thereafter. I further agree to report any license suspensions, serious accidents or offenses, or any other condition to my supervisor immediately that may affect my ability to drive a Willoughby Roofing & Sheet Metal, Inc. vehicle (or my own vehicle, if I am required to drive) after I am hired. I agree to obtain a Driver's license prior to hire if I do not already have one. I understand that the Company will use this information for employment purposes only and not furnish this information to a third party without my written consent. I agree to release Willoughby Roofing & Sheet Metal, Inc., its employees, and those who supplied you with the information from any liability for any damage which may result from furnishing the requested information or my failure to be hired for the position for which I am applying.