EMPLOYMENT APPLICATION

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended 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, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have 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 successful completion of a medical examination, which may include providing body substance samples. This application will remain active for 30 days.

PERSONAL INFORMATION

Last Name

First Name

Middle Name (Full)

Home Phone Number

Cell Phone Number

Email Address

Please list below your current address and your two most recent previous addresses:

Current Street

City, State & Zip

Since (Mo/Yr)

Previous Street

City, State & Zip

Since (Mo/Yr)

Previous Street

City, State & Zip

Since (Mo/Yr)

EDUCATION

School (Include City & State)

Areas of Study

Degree/Diploma Earned

GPA

EMPLOYMENT INFORMATION

Position Applied For:

Date you Can Start Work:

Desired Compensation:
$

Do You Prefer:     Full Time Part Time Can You Work:     Weekends Evenings

Please answer all of the following questions. When necessary, note question number & use additional paper to provide explanation:

1. Are you at least 18 years of age and legally eligible for work in the United States?  YES NO
2. Will you work overtime when necessary?  YES NO
3. Have you received a description of the job or been made aware of the essential functions of the job you are applying for?  YES NO
4. Do you understand the job requirements?  YES NO
5. Are you on layoff and subject to recall?  YES NO
6. Have you ever been discharged or asked to resign from a job?
(If yes, please explain) 		 YES NO
7. * Have you ever been convicted of a criminal offense?
(If yes, please explain, including date, place and nature of the offense) 		 YES NO
8. * Are you currently under indictment or awaiting trial for a criminal offense?
(If yes, please explain) 		 YES NO
* An affirmative answer will not automatically disqualify you from being considered for employment.
9. Are you currently under a non-compete agreement from a previous or current employer?
(If yes, please explain) 		 YES NO

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER?  YES NO

Starting with your most recent employer, provide the following information:

Most Recent Employer
 Phone Number
Street Address
 City
 State
 Zip Code
Position Held
 Dates From/To
 Pay Rate Upon Leaving
$ 		Supervisor
Duties
 Reason for Leaving
Next Most Recent Employer
 Phone Number
Street Address
 City
 State
 Zip Code
Duties
 Reason for Leaving
Next Most Recent Employer
 Phone Number
Street Address
 City
 State
 Zip Code
Duties
 Reason for Leaving
Next Most Recent Employer
 Phone Number
Street Address
 City
 State
 Zip Code
Duties
 Reason for Leaving
Please explain any gaps in your employment, other than those due to personal illness, injury, or disability.

RMCN checks Employment References. In order to provide RMCN Credit Services, Inc. with information and opinions that may be useful in its hiring decisions, I hereby authorize any person, school, current or past employer, organization or entity disclosed in my resume, application, or during my interview to provide any information regarding me including without limitation, information concerning my performance, reputation and character. I acknowledge that the information divulged may be negative or positive with respect to me. Nevertheless, pursuant to this authorization, I unconditionally release such person, school, employer, organization or entity from any legal liability for furnishing such information and in making such statements

A Photocopy of this signed release shall have the same force and effect as the original release signed by me.

 I have read and agree to the above statement  

List the name of three school or personal references if you do not have any employment history:

REFERENCES

Name Relationship Phone Number Number of Years Known

JOB-RELATED SKILLS

Please use this space to list any special skills, training, licenses and/or certificates that may assist you in performing the position for which you are applying.



Computer Skills (Check the appropriate boxes. Include software titles and years of experience.)

 Microsoft Word Years – Level:  Beginner Intermediate Advanced  Typing WPM
 Microsoft Excel Years – Level:  Beginner Intermediate Advanced  10 Key Strokes
 Microsoft Outlook Years – Level:  Beginner Intermediate Advanced  Other

APPLICANT'S CERTIFICATION AGREEMENT

 I authorize the investigation by the company 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.
 I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on the application (or on any required documents)will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
 I agree, if I am offered and accept a position, to conform 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, and that my at-will status can only be altered by an express written agreement signed by myself and an officer of the Company.
 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.
 I certify that I have read and reviewed the information provided in this application. I certify that I fully understand and accept all terms of the foregoing Applicant Statement. I certify that I have answered all questions completely and fully.

How did you hear about employment opportunities with RMCN?

 

Enter the text from the image below