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 About Us > Job Opportunities > Apply Now
R.A. NELSON & ASSOCIATES EMPLOYMENT APPLICATION

APPLICANT NOTE:

The application form is intended for use in evaluating your suitability for employment. It is not an employment contract. Please answer all appropriate questions completely and to the best of your ability. False or misleading statements are grounds for refusal or termination of employment and benefits. Federal law provides penalties for false statements or documents related to U.S. employment eligibility. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, religion, pregnancy, creed, national origin or the presence of non-job related handicaps. A felony conviction will not necessarily bar the applicant from employment, and affirmative action hiring of handicapped individuals, disabled or Vietnam-era veterans, minorities and women may be requested by qualified applicants. Additional testing of job-related skills, mental/physical abilities, physical conditions and for the presence of drugs in your body may be required prior to employment.

APPLICANT INSTRUCTIONS:

  1. Complete all sections of this form.
  2. Use comments section if additional space is needed.
  3. Incomplete or illegible applications will not be processed.
  4. If you need accommodation in the application process, we would be happy to provide it. Please inform us of your needs at the time you make your application.
Name: 
Last
First
Middle
Maiden
SSN: 
Home Phone:      Work Phone: 
Current Address: 
Street
City
State
Zip
Emergency Contact: 
Name
Phone
AVAILABILITY:
For which position are you applying?
 What date can you start?
What category would you prefer?  Full-time Part-time Temporary Labor Pool
For which schedules are you available?  Weekdays Overtime
Are you legally authorized to work in the U.S.?  Yes No
JOB-RELATED SKILLS: (Note: Do not fill out any part of this section you believe to be non-job related).
List languages in which you are fluent: 
Do you have a valid driver's license?  Yes State of Issue: 
DL #:      Type of driver's license: 
Endorsements:      Restrictions: 
List any moving violations: 
List any other skills, licenses, or certificates that are job related: 
Have you been given a job description or had the job requirements explained to you?  Yes No
Do you understand these requirements?  Yes No
Can you perform the requirements of this job with or without reasonable accommodation?  Yes No
SECURITY:
List states and counties of residence for the past seven years: 
Have you been convicted of a felony and/or served time for a felony in the past seven years?  Yes No
If so, please describe: 
REFERENCES:
Include only individuals familiar with your work ability (not relatives).
NAME ADDRESS/PHONE YEARS KNOWN/RELATIONSHIP
ADDITIONAL INFORMATION YOU WOULD LIKE TO PROVIDE: 
EDUCATION:
Highest grade completed: 7   8   9   10   11   12   13   14   15   16+
NAME CITY/STATE DATES GRADUATE?
High School
College
Other
EXPERIENCE: Please put most recent employer first.
Most Recent Employer
 Name of Employer
 Name of Employer
Street Address
 Street Address
 Street Address
City, State, Zip Code
 City, State, Zip Code
 City, State, Zip Code
Telephone Number
 Telephone Number
 Telephone Number
Supervisor's Name

May we contact?
Yes No 		Supervisor's Name

May we contact?
Yes No 		Supervisor's Name

May we contact?
Yes No
Dates Employed
Start
End 		Dates Employed
Start
End 		Dates Employed
Start
End
Salary
Start
End 		Salary
Start
End 		Salary
Start
End
Position/Duties
 Position/Duties
 Position/Duties
Reason for Leaving
 Reason for Leaving
 Reason for Leaving