RRHC Job Application Form

RRHC Job Application Form

Equal access to programs, services, and employment opportunities is available to all persons without regard to age, ancestry, color, disability, genetic information, gender, gender identity, gender expression, marital status, medical condition, military or veteran status, national origin, race, religion, sex (includes pregnancy, childbirth, lactation accommodation, and/or related medical conditions), sexual orientation, or any other basis protected by federal, state, and/or local law. In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resource Department.
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone Number
Please enter a valid phone number.
Cellular/Other Phone Number
Please enter a valid phone number.
Email
example@example.com
Position(s) applied for
Referral Source
If necessary, best time to call you is
Best Phone Number to Call you is:
Please enter a valid phone number.
May we call you at work?

Yes No
If yes, best time to call you at work:
Have you submitted an application here before?

Yes No
If yes, give date(s) and position(s):
Have you ever been employed here before?

Yes No
If yes, give dates of employment:
Are you lawfully authorized to work in the United States?

Yes No
Date available for work

Year Month Day
Date
What is your desired salary range or hourly rate of pay?
Type of employment desired:

Full-time Part-time Educational co-op Seasonal Temporary Telecommuting only
Will you work overtime if required?

Yes No
If no, please explain:
Are you able to preform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes No Need more information about the job's "essential functions" to respond
Employment History
Employment History
Employment History
Explain any gaps in your employment, other than those due to personal illness, injury, or disability:
If not addressed above, have you ever been fired or asked to resign from a job?

Yes No
If yes, please explain:
Computer Skills
Educational Background
Educational Background
References
References
References
Related Information
Applicant Statement DO NOT SIGN UNTIL YOU HAVE READ THE APPLICANT STATEMENT BELOW. I certify that all information I have provided is order to apply for and secure work with this employer is true, complete, and correct. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I herby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer. I understand that any information proved by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL TERMS OF THE FORGOING APPLICANT STATEMENT.

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