Application For Employment

Date*

Please Answer All Questions. Résumés Are Not A Substitute For A Completed Application.

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

For Rhode Island Employers Only: This Company is subject to the Workers' Compensation laws of the State of Rhode Island.*

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Applicant Name*

Position Applied For (list only one)*

Telephone Number*

Alternate/Cellular Telephone Number*

Present Address*

City*

State*

ZIP*

How long have you lived there (Years/Months)*

Email Address (optional)*

Type of employment desired?
Full TimePart Time

(Specify Hours)*

Are you willing to work overtime?
YesNo

Date on which you can start work if hired*

Have you previously applied for employment with this Company?
YesNo

If applicable, below list any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc.*

Education	School Name and Location (Address, City, State)	Course of Study or Major	Graduate? Y or N	# of Years Completed	Honors Received
High School
College
Graduate/ Professional
Trade or Correspondence

WORK EXPERIENCE

Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer "see résumé."

Name*

Address*

Type of business*

Telephone*

Dates Employed (From)*

To*

Job Title*

Duties*

Supervisor's Name*

May we contact?* YesNo

Reason for Leaving?*

What will this employer say was the reason your employment terminated?*

Were you ever disciplined? If so, for what?*