Recruitment Application Form

Employment Application
RCM Utilities, LLC is an equal opportunity employer and does not discriminate against otherwise qualified applicants based on race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. RCM Utilities is a drug-free workplace.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Phone Number
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date

MonthDayYear
Employment Desired:
Position Applying For
Full Time or Part Time?

Full TimePart Time
Date You Can Start

MonthDayYear
Date
Salary Desired ($)
Do you have the legal right to work in the United States?

YesNo
Do you have reliable transportation?

YesNo
Have you worked here before?

YesNo
Previous Position
Previous Start Date

MonthDayYear
Date
Previous End Date

MonthDayYear
Date
Are you currently employed?

YesNo
If no, how long since last employment?
Is there any reason you might be unable to perform the functions of the job for which you are applying?

YesNo
If yes, please explain.
How did you hear about RCM Utilities?
If you were referred, please provide the persons name.
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

YesNo
If no, GED?

YesNo
College and/or Vocational School
Name of College/University Attended
Number of Years Attended
Major/ Areas of Study
Degrees Earned
Other Training
School Name
Degree or Certificate Earned
School Name
Employment History:
Current Employer
Name
Position
Current Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
May We Contact?

YesNo
Contact Person
Phone Number
Please enter a valid phone number.
Previous Employer
Name of Previous Employer
Position
Previous Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Contact Person
Phone Number
Please enter a valid phone number.
Previous Employer
Name of Previous Employer
Position
Previous Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Contact Person
Phone Number
Please enter a valid phone number.
Experience & Qualifications:

	State	License No.	Type	Expiration Date
Driver License

Please upload a copy of your driver's license here.

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SKILLS: List tools and equipment you are proficient with.
If you wish to describe addition work experience or skills, please add as an attachment.

Accident Record for the last 3 Years

	Date	Accident Description	Fatailities	Injuries
Accident Record 1
Accident Record 2
Accident Record 3

Traffic Convictions & Forfeitures for the last 3 Years

	Date	Location	Charge	Penalty
Violation 1
Violation 2
Violation 3

Have you ever been discharged or asked to resign from job?

YesNo
Has any license, permit, or privilege ever been suspended or revoked?

YesNo
During the last 10 years, have you ever been convicted of a crime other than a minor traffic offense?

YesNo
(A conviction will not necessarily or automatically disqualify your for employment. Rather, such factors as age, date of conviction, seriousness and nature of the crime, and rehabilitiation will be considered.)
If you answered yes to any of the three previous questions, please explain below.
Resume (Optional):
Resume

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Send Application:
I herby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize RCM Utilities, LLC to veify their accuracy and obtain reference information on my work performance. I hereby release RCM Utilities, LLC from any/all liability of whatever kind and nature which, at any time could result from obtaining and having an employment decision on such information.

I understand that, if employed, falsified statemetns of any kind or omissions of facts called for on this applicaiton may and shall be considered enough basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I willfully adhere to the policies, rules, and regulations or employment at RCM Utiltiies. I further understand that neither the policies rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understant that any employment offered is for an indefinite duration and at will, and that either I or the Employer may terminate my employment at any time with or without notice or cause.
Date

MonthDayYear
Date
Signature

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Employment Application

Personal Information:

Employment Desired:

Education:

Employment History:

Experience & Qualifications:

Resume (Optional):

Send Application: