Job Application
All current job postings can be found in our new portal. Please visit https://rochester100inc.appone.com/
Full Name
*
First Name
Middle Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
What hours are you looking for?
*
Please Select
Full time
Part time
Please describe the type of work you are looking for?
*
Are you a citizen of the United States?
*
Yes
No
Are you authorized to work in the U.S.?
*
Yes
No
Are you 18 years or older?
*
Yes
No
Have you ever worked for Rochester 100 before?
*
Yes
No
Please select the date you started:
-
Month
-
Day
Year
Date
Please select the date you left:
-
Month
-
Day
Year
Date
Have you ever been convicted of a felony?
Yes
No
If you have been convicted of a felony please explain:
Have you graduated from high school or any higher education?
Yes
No
Last School Attended
Degree
Address of Last School Attended
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you graduate?
Yes
No
Start date of last school attended:
-
Month
-
Day
Year
Date
End date of last school attended:
-
Month
-
Day
Year
Date
Do you know anyone that currently works at Rochester 100 Inc that you would use as a reference?
Yes
No
Please List anyone you know who works here:
First Name
Last Name
Relationship to individual listed above.
Please List anyone you know who works here:
First Name
Last Name
Relationship to individual listed above.
Please List anyone you know who works here:
First Name
Last Name
Relationship to individual listed above.
Can you stand for long periods of time?
Yes
No
Can you sit for long periods of time?
Yes
No
Can you lift over 10lbs?
Yes
No
Can you lift over 50lbs?
Yes
No
Do you have any physical limitations we should be aware of
Yes
No
If you have any physical limitations we should be aware of please explain:
Do you require any accommodations to perform the job?
Yes
No
If you require any accommodations to perform the job please explain:
Previous Employer Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address of previous employer:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Job Title
Responsibilities
Reason for leaving
May we contact your previous supervisor for a reference?
Yes
No
Have you ever served in the military?
Yes
No
Branch
Rank at discharge
Type of discharge
If other than honorable please explain
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Do you require any time off for any planned events (i.e., vacation) during the upcoming 10 months?
Yes
No
If you require any time off for any planned events (i.e., vacation) during the upcoming 10 months please explain:
Signature
How did you hear about us (Optional)
Please Select
General Web Search for Jobs
Event
Social Media
Company Website
Family / Friend
Available Start Date (Optional)
/
Month
/
Day
Year
Date
Upload Your Resume (Optional)
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Rochester 100, Inc. 40 Jefferson Road, Rochester, NY 14623
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