Rose and Barrett Application Form

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely it is intended to provide information neccessary to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion age, the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the succeddful completion of a medical examination, whihc may include a drug test or other physical evaluations. We are an equal opportunity employer and drug-free workplace. This application will remain active for 180 days.

Personal Information:
First Name:
Last Name
Middle Name:
Home Phone:
Cell Phone:
  
Please list below your current address and one other most recent previous addresses:
Current Street:
 City:
 State:
Zip:
 Since (Mo/Yr) :
  
     
Previous Street:
 City:
 State:
Zip:
 Since (Mo/Yr) :
  
     
EMail Address :
    
     
Education:    
High School Attended:
 City:
 County:
State:
 Did you earn a diploma?

 
Undergraduate College Attended:
 City:
 State:
Area of study:
Degree/Certificate/Diploma
  
Graduate School Attended:
 City:
 State:
Area of study:
Degree/Certificate/Diploma
  
Trade, Business or Other School:
City:
 State:
Area of study:
Degree/Certificate/Diploma
  
     
Employment Information:    
Position Applied For :
 Date you can start:
 Desired Salary:
Do you prefer:
 
Full Time
Part Time

Can You Work:
 
Weekends
Evenings
Both

Please answer the following questions:
1. Are you at least 18 years of age and legaly eligible for work in the United States? (If yes, please explain)
 
Yes No
Explain:

2. Will you work overtime when necessary? (If yes, please explain)
 
Yes No
Explain:

3. Have you received a description of the job or been made aware of the essential functions of the job you are applying for? (If yes, please explain)
 
Yes No
Explain:

4. Do you understand the job requirements? (If yes, please explain)
 
Yes No
Explain:

5. Are you on layoff and subject to recall? (If yes, please explain)
 
Yes No
Explain:

6. Are you currently bound by a non competition of trade secret agreement? (If yes, please explain)

 
Yes No
Explain:

7. Have you ever been discharged or asked to resign from a job? (If yes, please explain)

 
Yes No
Explain:

8. Have you ever been convicted of or pled guilty to a felony or other crime? (If yes, please explain)
 
Yes No
Explain:
Employment History:

  May we contact your present employer? Yes No
Most recent employer:
Name:
 City:
 State:
Zip Code:
 Phone:
 Position Held:
Employment began (MM/DD/YY):
 Employment ended (MM/DD/YY):
 Pay Rate Upon Leaving:
Supervisor Name:
Duties:
 Reason for leaving:
Next most recent employer:
Name:
 City:
 State:
Zip Code:
 Phone:
 Position Held:
Employment began (MM/DD/YY):
 Employment ended (MM/DD/YY):
 Pay Rate Upon Leaving:
Supervisor Name:
Duties:
 Reason for leaving:
Next most recent employer:
Name:
 City:
 State:
Zip Code:
 Phone:
 Position Held:
Employment began (MM/DD/YY):
 Employment ended (MM/DD/YY):
 Pay Rate Upon Leaving:
Supervisor Name:
Duties:
 Reason for leaving:
Next Most recent employer:
Name:
 City:
 State:
Zip Code:
 Phone:
 Position Held:
Employment began (MM/DD/YY):
 Employment ended (MM/DD/YY):
 Pay Rate Upon Leaving:
Supervisor Name:
Duties:
 Reason for leaving:
Job Related Skills:

If the job you are applying for requires driving a motor vehicle, please answer the following questions:

1. Do you have a valid drivers license?
 
 
If yes, drivers license number:
Date of Issue :

2. Have you been convicted of or pled guilty to any traffic-related offenses within the past five years?

   

3. Have you had your drivers license suspended or revoked, or had your driving privileges modified by a court of law?

   
4. Please list all states from which you hold or have held a drivers license:
Please use this space to list any special skills you may have that relate to the position applied for:
Please list any professional licenses, designations, certifications, etc that may relate to the position applied for. Include date granted, name of organization, any any other relevant information:
1.

2.

3.

Copy and paste resume:

Applicant's Certification Agreement:

  1. I certify that the facts and information set forth in this application are true and complete of the best of my knowledge. I understand that a falsification, misrepresentation, or omission of facts on the application (or any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
  2. I authorize the investigation of all statements contained in the application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.
  3. If I am offered and accept a position, I agree to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.
  4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
  5. I have read and reviewed the information provided in this application and the above statements. By submitting this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.

By clicking the “send” button below, I hereby agree to the APPLICANT’S CERTIFICATION AGREEMENT
 

 
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