Thank you for your interest in careers at SRRA.
Please note that, because this file will be encrypted to keep your data and information safe, you cannot save this form to continue later. Paper applications are available at the SRRA Headquarters building at 11325 Norton-Coeburn Road, Coeburn,VA, 24230 during the hours of 8am and 5pm Monday through Thursday or via e-mail marketing@srra.org.
Name
*
First Name
Middle Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you legally entitled to work in the United States?
*
Yes
No
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Position
Information about the Role
Which position are you applying for?
*
Please Select
Maintenance Specialist
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?
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Yes
No
What type of role are you willing to accept? (select all that apply)
*
Full-Time
Part-Time
Temporary
Which shifts are you able to work? (select all that apply)
*
Days
Weekends
What date would you be available to begin work?
*
-
Month
-
Day
Year
Date
What salary do you desire for this role? Please indicate annual or hourly.
*
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Education
Please list your most recent educational achievements first.
Are you a high school graduate or have you obtained a general education degree (GED)?
*
Yes
No
College, Business School or Military Education (1)
Name of Institution
*
Location of Institution
*
City, State, Zip
Did you graduate from this institution?
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Yes
No
Degree Obtained
*
Major or Field of Study
*
Date of Completion (or Forecasted)
*
-
Month
-
Day
Year
Date
College, Business School or Military Education (2)
Name of Institution
Location of Institution
City, State, Zip
Did you graduate from this institution?
Yes
No
Degree Obtained
Major or Field of Study
Date of Completion (or Forecasted)
-
Month
-
Day
Year
Date
College, Business School or Military Education (3)
Name of Institution
Location of Institution
City, State, Zip
Did you graduate from this institution?
Yes
No
Degree Obtained
Major or Field of Study
Date of Completion (or Forecasted)
-
Month
-
Day
Year
Date
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Employment History
Please list your most recent work experience first. Include volunteerism and military experience.
Work Experience (1)
Employer (Business or Entity Name)
*
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Job Title at this Employer
*
Type of Employment:
*
Full-Time
Part-Time
Your Supervisor's Name
*
Last Salary in this Role
*
Date Employment Began
*
-
Month
-
Day
Year
Date
Date Employment Ended
*
Outline Specific Duties in this Role
*
Reason for Leaving this Role
*
May we contact this employer?
*
Yes
No
Work Experience (2)
Employer (Business or Entity Name)
*
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Job Title at this Employer
*
Type of Employment:
*
Full-Time
Part-Time
Your Supervisor's Name
*
Last Salary in this Role
*
Date Employment Began
*
-
Month
-
Day
Year
Date
Date Employment Ended
*
Outline Specific Duties in this Role
*
Reason for Leaving this Role
*
May we contact this employer?
*
Yes
No
Work Experience (3) Optional
Employer (Business or Entity Name)
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Job Title at this Employer
Type of Employment:
Full-Time
Part-Time
Your Supervisor's Name
Last Salary in this Role
Date Employment Began
-
Month
-
Day
Year
Date
Date Employment Ended
Outline Specific Duties in this Role
Reason for Leaving this Role
May we contact this employer?
Yes
No
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Additional Information
Documents and Statements for Consideration
Resume
*
Upload a File
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Choose a file
Acceptable Files: pdf, doc, docx, csv, txt, rtf, html, jpg, jpeg, png
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Cover Letter (Not Required but Encouraged)
Upload a File
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Choose a file
Acceptable Files: pdf, doc, docx, csv, txt, rtf, html, jpg, jpeg, png
Cancel
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What interests you in this role?
*
Please List Any Relevant Trainings or Certifications and Completion Dates
*
If none, write "none".
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References
Please list two (2) references that are familiar with your work life.
Reference #1 Name
*
First Name
Last Name
Reference Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference's Relationship to Applicant
*
Reference's Current Employer
*
Reference's Current Job Title
*
Reference #2 Name
*
First Name
Last Name
Reference Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference's Relationship to Applicant
*
Reference's Current Employer
*
Reference's Current Job Title
*
Please verify that you are human
*
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