APPLICATION FOR EMPLOYMENT
RACKLEY COMPANY, INC.
3772 COUNTY RD 99W
Clean Drivers License:
*
Yes
No
Out of Town Travel:
*
Yes
No
Fear of heights:
*
Yes
No
PERSONAL INFORMATION:
Today's Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NAME:
*
First Name
Middle Initial
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date Picker Icon
CURRENT ADDRESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER:
*
Format: (000) 000-0000.
EMERGENCY CONTACT:
*
First Name
Middle Initial
Last Name
EMERGENCY CONTACT PHONE NUMBER:
*
Format: (000) 000-0000.
NAME OF ANY RELATIVES/FRIENDS EMPLOYED BY RACKLEY COMPANY
RELATIONSHIP OF INDIVIDUAL LISTED ABOVE
WERE YOU REFERRED BY ANYONE? PROVIDE THEIR NAME
EMPLOYMENT DESIRED:
POSITION:
*
DATE YOU CAN START:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ARE YOU CURRENTLY EMPLOYED?
*
YES
NO
MAY WE CONTACT YOUR EMPLOYER?
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?
*
YES
NO
IF YES, WHEN?
FORMER EMPLOYERS: LIST YOUR LAST 3 EMPLOYERS, STARTING WITH PRESENT OR MOST RECENT.
*
Rows
NAME AND ADDRESS OF EMPLOYER
POSITION
REASON FOR LEAVING
DATES OF EMPLOYMENT
1
2
3
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EDUCATION:
EDUCATION:
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Rows
NAME AND LOCATION
DIPLOMA / GED
YEAR
Remarks
HIGH SCHOOL
COLLEGE
OTHER
SPECIAL TRAINING:
ACTIVITIES/HOBBIES: (CIVIC, ATHLETIC, ETC.)(EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, AGE, COLOR, OR NATIONAL ORIGIN OF ITS MEMBERS.)
Are you able to lift 75 pounds?
*
Yes
No
OTHER: INCLUDE EXPLANATION
DRUG SCREENING PRACTICES
Rackley Company requires pre-employment drug screens and additional screens per our company policy established in 1997.
Prospective Employee's Signature Indicates That You Understand Above Statement
*
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REFERENCES:
GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
*
Rows
NAME
ADDRESS
PHONE NUMBER
YEARS ACQUAINTED
1.
2.
3.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT AND PREVIOUS NOTICE.
Email Address:
*
example@example.com
SIGNED:
DATE:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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