Application for Employment

Hi, we’re glad you’re considering our company and we look forward to learning about you and your career interests.

We’re committed to offering a work environment that is rewarding, friendly & fair ... we are an Equal Opportunity Employer and operate in accordance with Title VII of the Civil Rights Act of 1964; race, color, religion, age, sex, national origin, veteran status and disability are prohibited from influencing employment, promotion and compensation decisions.

So go ahead, fill out the information below, we’d love to explore opportunities with you!

Full Name *
Preferred First Name *
Cell Phone # *
Home Phone # *
Email *
Confirm Email *
Address *
City / State / Zip *
Position Desired *
Desired Salary Range *
Date Available *

How did you learn of this position? Specify any hours or days you will not work: Have you ever been convicted of a felony? *
Yes No

If yes, when, where, and for what? Have you ever been convicted of a DUI or DWI? *
Yes No

If yes, when, where, and for what? Are you willing to travel on business? *
Yes No

Education

High School You Graduated From City / State Scholastic Honors, Relevant Training Completed and Extra-Curricular Activities College / University Name City / State Number of Years Attended Major / Degree

College / University Name City / State Number of Years Attended Major / Degree Scholastic Honors, Relevant Training Completed and Extra-Curricular Activities

Employment History

Please list employment for the last 10 years, starting with your current or most recent position. Complete the first group of questions even if attaching a resume. Please Note: Deliberate failure to list an employer will be considered falsification of your application and will provide a basis for your not being considered further for employment, or for the termination of your employment if the omission is discovered after you are employed.

Current / Most Recent Employer

Company * Dates of Employment * Company Phone # * Your Supervisor * Your Title or Position *
If this is your current employer, may we contact them? * Yes No

Reason for Leaving * Current or Ending Salary *

Previous Employer 1

Company Company Phone # Address City / State Employed From Employed To Your Supervisor Your Title or Position Reason for Leaving Salary Upon Leaving

Previous Employer 2

Company Company Phone # Address City / State Employed From Employed To Your Supervisor Your Title or Position Reason for Leaving Salary Upon Leaving

Previous Employer 3

Company Company Phone # Address City / State Employed From Employed To Your Supervisor Your Title or Position Reason for Leaving Salary Upon Leaving

Previous Employer 4

Company Company Phone # Address City / State Employed From Employed To Your Supervisor Your Title or Position Reason for Leaving Salary Upon Leaving

To upload a resume as a .doc, .docx, or .pdf file, please use this utility:

Upload Resume:

By pressing 'Submit': * I certify

that the information stated on this application is true and complete to the best of my knowledge and that I have withheld nothing that would reflect unfavorably upon me. I understand that if hired, any false statements or omissions on this application could result in my immediate termination.I hereby authorize R.K. Black, Inc. to contact my previous employers. By signing below, I expressly authorize my prior employer(s) to provide information regarding my employment, my performance, my separation from the company, and any other matters they deem relevant. I expressly release my prior employer(s) from any liability for any information provided in connection with my prior employment as long as it is provided in good faith and is reasonably believed by my prior employer(s) to be true.

I understand that my employment is “At Will”, and that the employer / employee relationship can be terminated at any time with or without prior notice. I acknowledge that I have read, understand and accept the above statements.

What does

equal?

Application for Employment

Education

Employment History

Current / Most Recent Employer

Previous Employer 1

Previous Employer 2

Previous Employer 3

Previous Employer 4

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