application for employment

APPLICATION FOR EMPLOYMENT
Please fax to 877-273-2217 or email to [email protected]
GENERAL INFORMATION
Name (Last)
(First)
Address (Mailing Address)
(City)
E-Mail Address
(Middle Initial)
(State)
(Zip)
Home Telephone
Other Telephone
Are you legally entitled to work in the U.S.?
POSITION
Position Or Type Of Employment Desired
Will Accept:
Shift:
Are you able to perform the essential functions of the job you are applying for, with or
without reasonable accommodation?
Salary Desired
Region or Location
Applying for
Date Available
EDUCATION AND TRAINING
High School Graduate Or General Education (GED) Test Passed?
If no, list the highest grade completed
College, Business School, Military (Most recent first)
Name and Location
Dates
Attended
Month/Year
Credits Earned
Quarterly or
Other
Semester
(Specify)
Hours
Graduate
Degree
& Year
Major
or Subject
From
To
From
To
From
To
From
To
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Occupational License, Certificate or Registration
Number
Where Issued
Expiration Date
Languages Read, Written or Spoken Fluently Other Than English
VETERAN INFORMATION (Most recent)
Branch of Service
Date of Entry
SPECIAL SKILLS (List all pertinent skills and equipment that you can operate)
Date of Discharge
WORK EXPERIENCE (Most Recent First)
(Include voluntary work and military experience)
Employer
Address
Telephone Number
From (Month/Year)
Job Title
Specific Duties
Number Employees Supervised
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Reason For Leaving
May We Contact This Employer?
Employer
Address
Telephone Number
From (Month/Year)
Job Title
Specific Duties
Number Employees Supervised
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Reason For Leaving
Employer
Address
Job Title
Specific Duties
May We Contact This Employer?
Telephone Number
From (Month/Year)
Number Employees Supervised
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Reason For Leaving
May We Contact This Employer?
Employer
Address
Telephone Number
From (Month/Year)
Job Title
Specific Duties
Number Employees Supervised
To (Month/Year)
Hours Per Week
Last Salary
Supervisor
Reason For Leaving
May We Contact This Employer?
Do you have any limitations to working outside 95% of the year regardless of the weather conditions?
______________________________________________________________________________
Can you provide a previous occupation in which you worked mostly outside?
______________________________________________________________________________
Do you have any limitations with lifting up to 75lbs?
______________________________________________________________________________
Do you currently have any schedule conflicts Monday – Saturday? _______________________
If So – Please list
______________________________________________________________________________
Do you have any issue with completing a non-compete contract?
______________________________________________________________________________
Are you looking for a job or a career? ______________________
How many other companies have you applied with? _______________
Do you have reliable transportation? ____________________
Do you currently have any points on your driving record? _________________
If So Please Explain
______________________________________________________________________________
Are you willing to have a background check completed? ______________________
What interested you most in the job opportunities at RimGuard Xtreme?
______________________________________________________________________________
I certify the information contained in this application is true, correct, and complete. I understand that, if employed, false
statements reported on this application may be considered sufficient cause for dismissal.
By checking this box you have created an
electronic signature as legally binding as
your hand-written signature.
Date________________
Rim Guard Xtreme, Inc is a equal opportunity employers and providers of employment and training services.
Rim Guard Xtreme, Inc