INTAKE APPLICATION SCALO INC. TRADESPEOPLE IN TRAINING: PROFESSIONAL ROOFING PROGRAM The Scalo Companies in Collaboration with The Three Rivers Workforce Investment Board, Pittsburgh Works, Energy Innovation Center, CareerLink, and Goodwill Industries of Southwestern Pennsylvania

Print Name: ____________________________________________ Date available to start training: _________________ (FIRST, MIDDLE, LAST)

Address: __________________________________________________________________________________________ (Street Address)

(City/State)

(Zip Code)

Telephone Number: ______________________________ Email: _________________________________________ Date of Birth: _______________________________

Social Security Number: __________________________

(For Identification Purposes Only)

Driver’s License #: ________________________________ State of License Issued: _______________________ County in which you reside: _____________________________

Highest Level of Education: _________________

If you are working with an organization, job developer, or case manager: Contact Name: ___________________________________ Organization: ____________________________ Telephone Number: ________________________ and Email: _____________________________________ 1) 2) 3) 4)

ARE YOU OVER THE AGE OF 18: WILLING TO SUBMIT TO A BACKGROUND CHECK: LEGALLY ABLE TO WORK IN THE UNITED STATES: ABLE TO PASS A DRUG TEST PRE-TRAINING, PRE-HIRE, AND IF EMPLOYED, REGULARLY:

5) PHYSICALLY ABILITY TO PERFORM THE FOLLOWING: a) ABILITY TO LIFT 50-100LBS b) ABILITY TO STAND, PULL, BEND OVER AND WORK ON KNEES c) ABILITY TO WORK AT HEIGHTS AND USE LADDERS d) ABILITY TO WORK OUTDOORS AT VARY TEMPERATURES 6) WILLING TO WEAR AND MAINTAIN SAFETY EQUIPMENT: 7) DO YOU POSSESS A CURRENT DRIVER’S LICENSE: 8) CAN GAIN A DRIVER’S LICENSE WITHIN 6 MONTHS: 9) DO YOU HAVE ACCESS TO RELIABLE TRANSPORTATION THAT IS NOT A PUBLIC BUS:

(YES) (NO) (UNSURE) (YES) (NO) (UNSURE) (YES) (NO) (UNSURE) (YES) (NO) (UNSURE)

(YES) (YES) (YES) (YES) (YES)

(NO) (NO) (NO) (NO) (NO)

(UNSURE) (UNSURE) (UNSURE) (UNSURE) (UNSURE)

(YES) (NO) (UNSURE) (YES) (NO) (UNSURE) (YES) (NO) (UNSURE)

I hereby authorize Burns & Scalo Roofing, Co. or its agent to obtain a criminal background check on me in connection to consideration for a trainee position in the Scalo Professional Roofing Training Program. Signature: ______________________________________________ Date: ______________________________________

Email: [email protected]

Send Applications to Donna Bodnar by OR Mail: 22 Rutgers Road, Pittsburgh, PA 15205 (Attn: Donna Bodnar)