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First Name:

Middle Name:

Last Name:

Address:

Street:

City:

State:

Zip:

Position Desired:

Telephone Number:

Working

Full Time

Part Time

Temporary

Summer

Per Diem

Select days you can work

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Shifts:

Day

Evening

Night

Date Available to Begin:

Are you Legally qualified to be Employed in the USA?

Yes

No

Proof of Citizenship or immigration status

(Proof of Citizenship or immigration status will be required upon employment)

The New York State Human Rights Law

The New York State Human Rights Law prohibits discrimination in employment because of age.

Are you over 18 years of age?

Yes

No

Professional License or Registration

Professional License or Registration

If you have a Professional or Technical License, Registration, Certification, or Permit complete the following:

Type:

Number:

Issued by:

State:

Date: (from)

Date: (to)

Provide the past 5 years of employment as completely as possible

Provide the past 5 years of employment as completely as possible.

Starting with your present or most recent employer, including summer employment. If space is insufficient; list on an additional page or attach resume. For any unemployed or self-employed periods, show dates and locations. All data must be completely filled in. DO NOT write “see resume”.

Name and Address of Company:

Nature of Experience:

Job Title:

Supervisor:

Pay Rate:

Reason For Leaving:

Blank Space

Name and Address of Company:

Nature of Experience:

Job Title:

Supervisor:

Pay Rate:

Reason For Leaving:

Blank Space

Name and Address of Company:

Nature of Experience:

Job Title:

Supervisor:

Pay Rate:

Reason For Leaving:

May we contact your present employer?:

Yes

No

If NO please explain:

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We will get back to you as soon as possible.

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First and Last Name"

Street Address

City

State

Zip Code

Email:

Phone:

Has your driveway been sealed in the past?

Yes

No

N/A to this request

Is your driveway Newly Installed?

Yes

No

N/A to this request

Message:

Thank you for contacting Perfect Seal 716!

Our 2026 seal season has officially come to an end, and we're no longer scheduling sealing services this year.

We'll keep your contact information on file and contact you in March to begin scheduling for the upcoming season.

We appreciate your interest in Perfect Seal 716 and look forward to working with you!

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Contact Info

560 56th St

Niagara Falls, NY 14304

716-671-7644

Our Services

Parking Lot Striping

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