Application For Employment Applicants and employees are treated without regard to race, creed, religion, national origin, nationality, ancestry, age, sex/gender, marital status, civil union status, familial status, affectional or sexual orientation, gender identity or expression, domestic partnership status, atypical hereditary cellular or blood trait, genetic information, disability including perceived disability, physical, mental and/or intellectual disability, or liability for service in the Armed Forces of the United States. Last Name: First Name: Middle Name: Current Address: Daytime Phone: Evening Phone/Cell Phone: Date of Birth : (month/date/year) Permanent Address: Same as Above Alternate Email Address: Referral Source: Employee Wage or Salary Desired: Internet Newspaper Available Start Time Date: (month/date/year) Agency Job Fair Are you able to verify that you are old enough to work? College Yes No Other Are you interested in: Can you work: Are you willing to travel? Will You Relocate? Part-time Any Shift Yes No Yes No Overtime Full-time Domestic International Geographic Preference: Weekends Temporary OIF OEF Have you applied with us Have you ever been Do you have relatives currently If hired, can you provide Proof of before? employed with us before? employed with us? Citizenship or verification of legal right to Yes Yes Yes work in the U.S.? No No No Yes No
Application For Employment Applicants and employees are treated without regard to race, creed, religion, national origin, nationality, ancestry, age, sex/gender, marital status, civil union status, familial status, affectional or sexual orientation, gender identity or expression, domestic partnership status, atypical hereditary cellular or blood trait, genetic information, disability including perceived disability, physical, mental and/or intellectual disability, or liability for service in the Armed Forces of the United States. Last Name: First Name: Middle Name: Current Address: Daytime Phone: Evening Phone/Cell Phone: Date of Birth : (month/date/year) Permanent Address: Same as Above Alternate Email Address: Referral Source: Employee Internet Newspaper Agency Job Fair College Other Wage or Salary Desired: Available Start Time Date: (month/date/year) Are you able to verify that you are old enough to work? Yes No Are you interested in: Part-time Full-time Temporary Can you work: Any Shift Overtime Weekends Are you willing to travel? Yes No Domestic International OIF OEF Will You Relocate? Yes No Geographic Preference: Have you applied with us before? Yes No Have you ever been employed with us before? Yes No Do you have relatives currently employed with us? Yes No If hired, can you provide Proof of Citizenship or verification of legal right to work in the U.S.? Yes No
RLMForm_ApplicationForEmployment_1MAY2012_AMB.docx