Employment  
Message from Human Resources  
Employment Application  






































 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Employment
Employment Application

Date:
Name:
Email:
Other name under which records (employment, academic, etc.) may be kept:
Are you 18 or Older: Yes No
Present Address:
Home Telephone:
How were you referred to J&D Associates/ RSS ?

Have you ever worked for J&D Associates/ RSS or any of its subsidiaries or affiliates?
Yes No
If Yes Where?
Dates Worked:
Reason for Leaving:

In the past, have you been released from prison following a conviction or have you been convicted of a felony or misdemeanor (excluding minor traffic violations) or are you awaiting prosecution for a felony?   (Exclude sealed or expunged convictions.)
Yes No
Names of relatives in company employ:
For what position(s) are you applying?
Are you able to work:
Fulltime:
Parttime:
Date Available:

Education
Please list any education, training or specialized experience you feel relates to the position(s) applied for that would help you perform the work, such as high  school, colleges, degrees, licenses, vocational or technical programs, military training, foreign language proficiency, etc.

High School      
School Name:
Address:
Year Graduated:
Subject Studied:
College/University      
School Name:
Address:
Year Graduated:
Subject Studied:
Other      
School Name:
Address:
Year Graduated:
Subject Studied:
Degrees, licenses, special achievements, experience or training:

Employment History

WORK HISTORY -  Include U.S. Military Service Experience
(THE LAST FIVE YEARS OF YOUR WORK HISTORY MUST BE INCLUDED)

Present of Previous Employer:
Name of Employer:
Address:
Job Title:
Supervisor Name:
Supervisor Title:
Description of Work:
Start Date: Leaving Date:
Starting Pay: Final Pay:

Previous Employer:
Name of Employer:
Address:
Job Title:
Supervisor Name:
Supervisor Title:
Description of Work:
Start Date: Leaving Date:
Starting Pay: Final Pay:

Previous Employer:
Name of Employer:
Address:
Job Title:
Supervisor Name:
Supervisor Title:
Description of Work:
Start Date: Leaving Date:
Starting Pay: Final Pay:

References
Name:
Phone:
Occupation:
Years Known:

Name:
Phone:
Occupation:
Years Known:

Employment Understanding

Please carefully read the following before signing it, since it contains terms and conditions that affect your application and potential employment.

In exchange for J&D Associates/ RSS’s consideration of this application and my possible employment with J&D Associates/ RSS, I agree to the following terms and conditions:

1.

Authorization and Release:  I authorize J&D Associates/ RSS to conduct an investigation of my qualifications for employment.  I realize that the investigation may include contacting my current or prior employers and references unless I have indicate otherwise on this form.  I authorize any party contacted by J&D Associates/ RSS to disclose information about me and to fully respond to J&D Associates/ RSS’s inquiries.  I release any and all parties connected with the investigation from any and all claims or liabilities arising from the soliciting or furnishing of information as part of that investigation.
2. Employment at Will:  I understand that any employment I might obtain with J&D Associates/ RSS is at will.  I further acknowledge that company policies, manuals or other similar documents are meant to be explanations of current benefits or programs that are subject to change and they do not change the terms of my at-will employment.  I also understand that only senior corporate officers have the authority to change my at-will status, that any change must be in writing and signed by an officer, and that at any time or for any reason, I may resign my position or J&D Associates/ RSS may terminate my employment.
3. Alcohol and Drug Testing/Medical Exam:  I understand that J&D Associates/ RSS has a strong policy concerning alcohol and drug use and that after a conditional offer of employment, I will have to take and pass J&D Associates/ RSS’s drug-screening test and may be required to take a medical exam.  I also understand that during the course of my employment with J&D Associates/ RSS, I may be required to submit to a job-related medical exam and may be subject to drug and/or alcohol testing under certain conditions as defined by company policy.
4. Federal Drug Free Workplace Statement:  As  a federal contractor, J&D Associates/ RSS complies with the Drug Free Workplace Act.  The unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited in J&D Associates/ RSS’s workplaces.  I understand that as a condition of employment, each associate at J&D Associates/ RSS must (a) abide by the terms of this statement and (b) notify J&D Associates/ RSS in writing of any criminal drug-statute conviction for a violation occurring in the workplace no later than five calendar days after such conviction.  I also understand that within 30 calendar days after receiving notice of a workplace drug conviction, J&D Associates/ RSS will (a) take appropriate disciplinary action against the associate, up to and including termination, and/or (b) require the associate to satisfactorily participate in an associate assistance or rehabilitation program.
5. Criminal Record Check:  Unless restricted by law, I understand that in conjunction with my application for employment, J&D Associates/ RSS may conduct a criminal-record check of criminal convictions and pending prosecutions and that information obtained as a result of this record check may, but will not necessarily, result in my not receiving an offer of employment, withdrawal of my offer of employment, or termination of employment.
6. Discoveries and Inventions:  I agree to treat as for J&D Associates/ RSS’s sole benefit, any and all ideas, discoveries, inventions and/or improvements that I make, either alone or with others, at any time while I am employed with J&D Associates/ RSS and which relate to J&D Associates/ RSS’s business interest and which relate to my areas of responsibility or which result from any specifically assigned tasks.  I further agree to fully and promptly disclose and assign these items to J&D Associates/ RSS without any additional consideration or compensation.  In furtherance of this obligation, I agree at any time to sign any papers and do any acts which J&D Associates/ RSS may reasonably require of me to protect its right to these items.  (For California residents:  I understand that this Agreement becomes valid once I am employed by J&D Associates/ RSS; and I further understand that the requirements in this Agreement or Assignment to you will not apply to any invention that qualifies fully under the provisions of Section 2870 of the California Labor Code.)
7. Confidential Information:  During and after any employment with J&D Associates/ RSS, I will not divulge or appropriate for my own use or for the use of others, except as J&D Associates/ RSS may authorize or direct, any knowledge or information obtained by me during my employment and considered by J&D Associates/ RSS to be secret or confidential.

8.

 Authorization to Work in the United States:  I understand that if I am offered employment with J&D Associates/ RSS, I must provide documentation to establish that I am either a U.S. citizen or an alien lawfully authorized to work in the United States and that if I am unable to provide such documentation, my offer of employment may be revoked.

I verify that the information I have provided on this application is true and accurate and that I am legitimately seeking a job with J&D Associates/ RSS.  I understand that any omission of information requested or any false or misleading information that I furnish on or in connection with this application for employment may result in rejection of my application or termination of my employment.  By signing this application form, I certify that I have read and agree to the terms of the above employment understanding.

Applicant Name: Date: