Administrative Assistant Application
800 Williams Road Montrose, PA 18801 - (570)278-1080 - office@rhlcompanies.com
GENERAL INFORMATION
Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you 21 years or older?
Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?
Yes
No
Have you been convicted of any crime? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.
Yes
No
If yes, explain;
For field, driver, operator, and laborer positions: How long are you willing to stay out of town for work (please check all that apply)
1-2 nights a week
All week, home on weekends
A few weeks at a time
Education & Training
Last Grade Completed
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
College 1
College 2
College 3
College 4
Masters
Doctorate
Graduated or Degree
Yes
No
Major Courses Studied
Last High School Attended & Address:
College & University / Other School (Technical, Vocational, Graduate, etc.) and Address:
Type a question
Have you received any safety training?
Yes
No
If yes, explain:
If required, will you work? Select all that apply:
Rotating Shifts
Overtime
Saturdays
Sundays
Salary Requirements (per hour or per month):
Interests / Accomplishments: You may wish to list significant experience, interests and accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position(s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.
EMPLOYMENT RECORD
If currently employed, may we contact your employer?
Yes
No
Present or Most Recent Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Past Employment
Employer and Position Held:
Employed To - From:
Address:
Telephone:
Reason for leaving:
Personal References:
Reference:
Name:
Street Address Line 2
Relationship:
Telephone Number:
Postal / Zip Code
Reference:
Name:
Street Address Line 2
Relationship:
Telephone Number:
Postal / Zip Code
Date you can start:
State fully why you believe you are qualified for the position you are applying for:
Please verify that you are human
*
This certifies that this application was completed by me, and that all entries on it and information in it are true to the best of my knowledge.
Submit
Should be Empty: