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    Personal Data

    SSN (optional) //

    DATE //

    Last Name

    First Name

    Middle Name

    Telephone Number

     

    Address of Residence

    City

    State

    Zip Code

    Referred by

     

    Are you less than 18 years of age?
    YesNo

    Upon offer of employment, can you verify your legal right to work in the United States? YesNo

    Have you ever used another name?
    YesNo

     

    Drivers License Number

    State

    Exp. Date

    Currently Valid?
    YesNo

    Driving Record

     

    EMPLOYMENT DESIRED

    DATE AVAILABLE //

    SALARY DESIRED $ per hour

    Position desired or area of interest

    Names of friends/relatives employed here

     

    Are you employed now?
    YesNo

    If YES, may we contact your employer?
    YesNo

    May we contact your previous employers?
    YesNo

     

    Can you work overtime?
    YesNo

    Are you able to perform the essential functions of the job for which you are applying
    for without accommodation?
    YesNo

     

    EDUCATION/MILITARY SERVICE

    Please indicate any languages, other than English,
    that you

    Speak

    Read

    Write

     

    Grade School

    Location

    Grades Attended

    Did you graduate? YesNo

    Grades Average

    Favorite Subjects

     

    High School

    Location

    Grades Attended

    Did you graduate? YesNo

    Grades Average

    Favorite Subjects

     

    College

    Location

    Degrees/Units

    Did you graduate? YesNo

    Grades Average

    Favorite Subjects

     

    Other

    Location

    Degrees/Units

    Did you graduate? YesNo

    Grades Average

    Favorite Subjects

     

    Have you ever served in the U.S. Armed Services?
    YesNo

    If YES, Military training or duties:

     

    EXPERIENCE AND EMPLOYMENT HISTORY

    List last four employers, starting with the last one first.
    Include part-time, military, seasonal and unemployment.

    From:

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    Employer Name

    Salary

    Position/Duties

     

    To:

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    Address

    Reason for leaving

     

    From

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    Employer Name

    Salary

    Position/Duties

     

    To

    //

    Address

    Reason for leaving

    From

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    Employer Name

    Salary

    Position/Duties

     

    To

    //

    Address

    Reason for leaving

     

    From

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    Employer Name

    Salary

    Position/Duties

     

    To

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    Address

    Reason for leaving

     

    EMERGENCY INFORMATION

    In case of emergency, Notify     

    First Name

    Last Name

    Telephone Number

    Relationship

    Address

    City

    State

    Zip Code

     

     

    Comment Area (if needed)

     

    Acknowledgement

    1. I understand that if I am being considered for employment by FRANK RUSSELL INC., I will be required to submit to a post-offer physical and drug/alcohol testing (all of which will be paid for by FRANK RUSSELL INC., and authorize release of the physical exam and test results to FRANK RUSSELL INC. Applicants whose test results are positive (prohibited substances present) will not be eligible for further employment consideration. I will at my own expense provide a DMV report.

    2. I also understand that as part of my Application for Employment that at any time during the course of such employment, I may be required to be examined concerning my ability to perform any job in a manner that does not endanger my own health or safety or the health of others. I hereby authorize all providers of health care who examine me to disclose to my employer or any of its agents, representatives and employees, including attorneys, all medical information revealed during such examinations. I further authorize my employer to disclose such information to any person if at any time my medical condition is put at issue in any proceeding by myself or others. I understand this authorization will remain valid for five years from the date of this Application, and that if I become employed this authorization will remain in effect for five years after my employment terminates. I understand that I have the right to receive a copy of this authorization. I hereby waive any and all rights and claims I may have regarding FRANK RUSSELL INC., or its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

    3. Any acceptance of employment will be predicated upon the truthfulness of the written and verbal statements contained within this Application and pre-employment process. I understand that should my employer find any statement I have made is not truthful, any job extended to me may be withdrawn and, if employed, I may be subject to termination.

    4. I understand this Application of Employment is not to be confused as a guarantee of employment for a specific time. I further understand that my employment with FRANK RUSSELL INC., does not constitute any form of contract, implied or expressed, and such employment will be terminable at will either by myself or my employer upon notice of one party to the other. My continued employment is dependent on satisfactory performance and the continued need for my services as determined by FRANK RUSSELL INC.

    5. I grant my employer approval, after my termination of employment to release information which it may deem appropriate regarding my employment with or termination from FRANK RUSSELL INC., to anyone who has a reasonable basis for making such inquiry. So long as the information disclosed is not known by FRANK RUSSELL INC., to be accurate, FRANK RUSSELL INC., shall not incur legal liability of any nature in connection with furnishing of such information.

    6. I understand that my Application for Employment will be placed in an active status for a period of six months during which time it will be reviewed as job openings occur in my area(s) of job interest. I also understand that should I wish to continue being considered for job openings beyond the six month period, I must reapply by (a) submitting a new Application for Employment or by (b) submitting a letter requesting renewal of my Application and including an update of my qualifications, recent work history etc.

    7. I understand that I must comply with the Drug Free Workplace Act.

    I certify that I have read all of the above statements and that I understand them.

     

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