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Employee Application Form
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Your Personal Information
Your Name
(Required)
First
Last
Your Email Address
(Required)
Enter Email
Confirm Email
Your Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
How many years at this address?
(Required)
Who referred you to our company?
Have you applied to our company before?
(Required)
No
Yes
When? (month/year)
Are you of 18 years of age?
(Required)
Yes
No
Do you have reliable transportation to and from work?
(Required)
Yes
No
Desired wage?
If you are offered a position, When would you be available to begin work?
Are you legally eligible to work in the United States?
(Required)
Yes
No
Are you able to perform the essential functions of the job position with or without reasonable accommodations?
Yes
No
What reasonable accommodations, if any, would you require?
Have you ever been convicted of a crime, including traffic violations?
(Required)
Yes
No
If yes please describe
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
Please list any skills that you feel maybe useful for the job
Applicants Employment History #1
Employer Name
Employer Phone
Employer Address
Date of Employment
Job duties
Rate of Pay
Reason for Leaving
Applicants Employment History #2
Employer Name
Employer Address
Date of Employment
Job Duties
Rate of Pay
Reason for Leaving
Eduction
What year did you graduate?
Do you have a highschool diploma or GED
Yes
No
References
Please list any 2 people who would be willing to provide a reference for you.
Reference #1
Name
First
Last
Phone
Number of years known
Reference #2
Name
First
Last
Phone
Number of years known
Other Information
Please provide any information that you feel maybe helpful or that should be considered:
Certification
(Required)
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application , or if employment commences, immediate termination.
Verification Authorization
(Required)
I authorize RW Striping to contact current and former employers for verification purposes.
I DO NOT authorize RW Striping to contact current and former employers for verification purposes.
