Name (First & Last)* Date Referred By Permanent Address (Street) (City) (State) (Zipcode) Primary Telephone Number* Secondary Telephone Number Currently Employed? YesNo Have you Applied Before? Previous Application Date Can We Contact Your Current Employer? YesNo Employment History From Month/Year To Month/Year Employer Name Salary Position Reason For Leaving Employment 1: From Month/Year* Employment 1: To Month/Year* Employment 1: Employer Name* Employment 1: Salary* Employment 1: Position* Employment 1: Reason For Leaving* Employment 2: From Month/Year Employment 2: To Month/Year Employment 2: Employer Name Employment 2: Salary Employment 2: Position Employment 2: Reason For Leaving Employment 3: From Month/Year Employment 3: To Month/Year Employment 3: Employer Name Employment 3: Salary Employment 3: Position Employment 3: Reason For Leaving Employment 4: From Month/Year Employment 4: To Month/Year Employment 4: Employer Name Employment 4: Salary Employment 4: Position Employment 4: Reason For Leaving Training/Military Service/Specials Skills/Awards US Military Training In Any Of The Armed Forces Rank: Special Training: Special Skills: Awards/Certs/Licenses: Education Type Of School Name And Location Of School Years Attended Subjects Studied Degree Obtained HighSchool HighSchool: Name And Location Of School HighSchool: Years Attended HighSchool: Subjects Studied HighSchool: Degree Obtained College College: Name And Location Of School College: Years Attended College: Subjects Studied College: Degree Obtained Trade Or Business Trade Or Business: Name And Location Of School Trade Or Business: Years Attended Trade Or Business: Subjects Studied Trade Or Business: Degree Obtained References: Please provide (2) professional and (1) personal Name Business Contact Information Relationship Years Known Professional Reference 1: Name* Professional Reference 1: Business* Professional Reference 1: Contact Information* Professional Reference 1: Relationship* Professional Reference 1: Years Known* Professional Reference 2: Name* Professional Reference 2: Business* Professional Reference 2: Contact Information* Professional Reference 2: Relationship* Professional Reference 2: Years Known* Personal Reference 1: Name* Personal Reference 1: Business* Personal Reference 1: Contact Information* Personal Reference 1: Relationship* Personal Reference 1: Years Known* Are you able to perform all the physical aspects of the position that you are applying for i.e lift 50 lbs., bend, stretch, stand for extended periods of time, climb stairs, reach, twist, sit, walk, run? YesNo Do you have a valid driver's license? YesNo Are you able to stay out of town during the work week? YesNo Have you ever been convicted of a crime? YesNo(If yes, please explain): Tell us what makes you a good candidate to work for R&R and why you want to work for us.* Certification: I certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that if employed, falsified statements on this application shall be grounds for dismissal. In compliance with Federal Law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification documents upon hire. I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that my result from utilization of such information. I also understand that this is a drug free company, and I will be randomly tested. I understand that Florida is an AT WILL state. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and Health Insurance Portability and Accountability Act (HIPAA). Signature* Date Attach Your Resume [anr_nocaptcha g-recaptcha-response]
