PRESCREENING

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.

Are you at least 18 years of age?

Are you eligible to work legally in the United States?

Will you at any time require any form of work authorization, visa, or other immigration sponsorship?

Have you ever been employed with our organization?

If yes, in what capacity?

Do you know anyone who has been or is still employed by our organization?

If yes, then whom?

First Name

Last Name

Relationship

First Name

Last Name

Relationship

EMPLOYMENT PREFERENCES

Date available to begin work.

YYYY

Hourly Pay Desired

Do you have a vehicle?

Are you willing to drive your vehicle for work-related activities?

Are you willing to work weekends and holidays?

Are you willing to work overtime?

Are you willing to rotate shifts?

Please indicate your availability below:

Sunday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Monday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Tuesday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Wednesday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Thursday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Friday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Saturday (select all that apply)

8 am - 4 pm

4 pm - 12 am

12 am - 8 am

Not Available

All

Position for which you are applying

Referral Source

Newspaper

Employee Referral

Recruiter

Other

Tech School/College Placement

Temporary Service

State Employment Service

Check all that you may be interested in

Full-time

Part-time

Temporary/PRN

Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

Cell Telephone No.

(###)

###

####

Home Telephone No.

(###)

###

####

Business Phone No.

(###)

###

####

Email Address

Have you ever been convicted of a felony since your 18th birthday?

Yes

If you answered "yes" regarding felony conviction, please complete the following:

Provide Nature of Offense, Name & Location of Court, and Date of Conviction

Are any of your educational or employment records found under a different last name?

Yes

If yes, please give the last name(s).

Previous Last Name(s)

Have you ever been discharged or forced to resign from any position?

Yes

If yes, please give employer, date and reason.

Professional References

Please provide four professional references, including the person's name and telephone number.

Education & Training

Highest Grade Completed

Choose one.

Did you graduate from High School or obtain a GED?

Yes

Name and Location of Last School Attended

High School, Junior High or Elementary

RELATED SPECIAL TRAINING (CORRESPONDENCE, BUSINESS, TRADES, VOCATIONAL, ARMED FORCES SCHOOLS, ETC.)

Provide name and location of school(s), dates attended, courses/subjects completed, credit hours earned, and diplomas/certificates received.

COLLEGES AND UNIVERSITIES ATTENDED (UNDERGRADUATE & GRADUATE)

**Must be from a recognized accredited school - original transcript is required if hired** Provide name and location of school(s), dates attended, credit hours earned, type of degree earned (i.e. BA/BS), major, and minor.

RELATED LICENSES

Please provide entity professional license is issued by, field/trade specialization, license number, issue date, and expiration date.

Skills Information

Please use the space below to elaborate on skills above (i.e. words per minute for typing, other software skills, foreign languages spoken and written fluently)

Employment History

Please start with your most recent position.

May we contact your present employer?

Yes

Job 1

Starting Date

YYYY

Ending Date

YYYY

Employer/Company Name

Employer/Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of employment

Paid Work

Volunteer

Salary

Name & Title of Immediate Supervisor

Telephone Number

(###)

###

####

Reason for Leaving

Title of Position Held

Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

Job 2

Starting Date

YYYY

Ending Date

YYYY

Employer/Company Name

Employer/Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of employment

Paid Work

Volunteer

Salary

Name & Title of Immediate Supervisor

Telephone Number

(###)

###

####

Reason for Leaving

Title of Position Held

Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

Job 3

Starting Date

YYYY

Ending Date

YYYY

Employer/Company Name

Employer/Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of employment

Paid Work

Volunteer

Salary

Name & Title of Immediate Supervisor

Telephone Number

(###)

###

####

Reason for Leaving

Title of Position Held

Number & Job Title of Employees you Supervised

Describe job responsibilities in order of importance:

CONDITIONS OF EMPLOYMENT STATEMENT

Under penalties of perjury, I declare that my answers to the questions on this application and any necessary examinations and supplements are true and give Rauch, Inc. the right to investigate all information given and to secure additional appropriate information if necessary. In accordance with the law and my understanding of this statement, I authorize my current and former employers to give any information regarding my employment, together with all information regarding me, and hereby release from all liability or responsibility all persons, companies, or corporations furnishing such information in good faith. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. I understand that the completion of this application does not assure me of a position with Rauch, Inc. and does not obligate Rauch, Inc. to me in any way. I further understand that any misrepresentation herein may cause my application to be rejected and/or subject me to dismissal. Candidates selected for hire must pass a functional exam prior to employment. I am aware that the results will be made available to the Human Resources Director or a duly authorized representative. Rauch, Inc. is committed to a drug free work place to protect the safety of workers and the public and will comply with the Federal Drug Free Work Place Act, therefore, I may be subject to a random drug test. I also understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. I understand that this application and submitted attachments become a part of Rauch, Inc. records and will not be returned, reused or copied for me once submitted. By my signature (signified by typing your full legal name), I certify, authorize and acknowledge the above statements.

Signature

Signified by typing your full legal name

Date Application Submitted

YYYY

ADDITIONAL INFORMATION

Additional information (i.e., cover letter, resume, etc.) can be emailed to hroffice@rauchinc.org

VOLUNTARY INFORMATION

We are an equal opportunity employer and do not discrimnate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, gender identity, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.

To maintain accurate data, we request that you fill in the sections that apply to you. This information is being requested on a voluntary basis. You will not be subjected to adverse treatment either by providing the information or by opting not to complete these sections.

The only purpose this information serves is to assist us in promoting equal employment opportunities throughout our organization.

What's your gender

What is your race/ethnicity?

Are you disabled?

What is your veteran status?

I understand that any false statements in this application may be cause for rejection or termination of my employment with Rauch, Inc. I also grant permission to Rauch, Inc. to investigate my former employment and references, to my former employers and references to release information about me to Rauch, Inc. In consideration of my potential employment with Rauch, Inc, I absolve Rauch, Inc., former employers, and references from any liability with respect to providing information about me, including my employment and attendance records and reasons for termination. I understand that neither this document nor any offer of employment from the employer constitutes an employment contract, unless a specific document to that effect is executed by Rauch, Inc. and myself in writing.

Authorization

I agree to the statements of the authorization above.

I hereby Authorize this electronic signature submittal to serve as my legal signature.

Signature (enter full legal name)

YYYY

Application for Employment at Rauch

EEO/ADA Employer

Info

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