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Employment Application

General Information
Date:
Name:
E-Mail:
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 RSS?

Have you ever worked for 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 RSS’s consideration of this application and my possible employment with RSS, I agree to the following terms and conditions:

1.

I certify that all information I have provided in order to apply for work with the employer is true, complete and correct.
2. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
3.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.  I hereby waive any and all rights and claims I have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
4. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
5. I understand that this application remains current for only 30 days.  At the conclusion of that time, if I have not heard from the employer and shill wish to be considered for employment, it will be necessary to reapply and fill out a new application.
6. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract for employment for any specified period or definite duration.  I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
7.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.


I verify that the information I have provided on this application is true and accurate and that I am legitimately seeking a job with 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: