Employment Application Application for Employment Name* First Middle Last Phone*Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Desired Career Opportunity Rate of Pay Desired $ Hours*Full TimePart TimeAre you 18 Years of Age or Older?* Yes No Are you legally eligible for employment in the United States?* Yes No Regular Attendance is an essential job function and is required by all employees of R-Anell. Will you be able to meet this requirement?* Yes No Some Positions require climbing on ladders and scaffolds, working on roof trussed and roofs 6 feet above the ground, and lifting items of up to 70 pounds to a height of approximately 4 feet. Would you be able to perform these tasks?* Yes No Note: R-Anell will consider employment, without any regard to disability, a disabled applicant who satisfies the requisite skill, experience, education, and other job related requirements of the job and is capable of performing the essential requirements of the job with or without reasonable accommodations.Have you ever applied for employment or worked at R-Anell?* Yes No If yes please give dates and locations of prior employment with R-Anell:If hired, do you have access to reliable transportation, which ensures that you arrive to work on time and remain at work until the end of our assigned work day or shift?* Yes No Within the last 7 years, have you ever been convicted by any court, including a court of military justice, of a felony which has not been annulled or expunged or sealed by a court?* Yes No If yes, please indicate the date, place, and nature of each conviction and terms of probation (yes answer will not neccessarily result in disqualification).EducationHigh SchoolSelect the Highest Grade Level Completed*9th10th11th12thHigh School Attended City, State Graduated* Yes No If not a high school graduate, do you have a Equivalency diploma? Yes No CollegeCollege Attended Degree City, State Course of Study Job Knowledge / AbilitiesProduction Positions Experience Years of Experience Production Positions Experience Years of Experience Other ExperiencePrior Work HistoryMost Recent EmploymentDates: (From Month/Year To Month/Year)* Employer:* Phone: Rate of Pay: Supervisor's Name: May we contact this Employer? Reason for Leaving: Type of work performed* Next Employment HistoryDates: (From Month/Year To Month/Year)* Employer:* Phone: Rate of Pay: Supervisor's Name: May we contact this Employer? Reason for Leaving: Type of work performed* Next Employment HistoryDates: (From Month/Year To Month/Year) Employer: Phone: Rate of Pay: Supervisor's Name: May we contact this Employer? Reason for Leaving: Type of work performed Next Employment HistoryDates: (From Month/Year To Month/Year) Employer: Phone: Rate of Pay: Supervisor's Name: May we contact this Employer? Reason for Leaving: Type of work performed ReferencesName of Reference Phone Number Number of Years Known Name of Reference Phone Number Number of Years Known Name of Reference Phone Number Number of Years Known NamesHave you been known by any other name(s) which R-Anell will require to verify education, employment, and criminal records as furnished in this application?This information contained in this application is true to the best of my knowledge and belief and I understand and agree that any falsified, incomplete, omitted, or misleading statements by me in connection with the application may result in the rejection of my application or termination of my employment whenever such information might be discovered.I understand and agree that all information furnished in this application may be verified by the company, and I hereby authorize all individual and organizations named or referred to in this application and any law enforcement organization to give the company all information relative to such verification and hereby release such individuals and organizations from any and all liablility for any claim or damage resulting therefrom. If employed, I authorize the company to supply information about me to any entity with whom I might hereafter seek employment and or who has a legitimate reason to inquire of such information including but not limited to, lending institutions, government agencies and schools.I understand and agree that should I be offered employment by the company, I may be required to undergo drug and other physical examinations and that these examinations will be at company expense and are a condition of my employment.If accepted for employment, I hereby agree to abide by all rules and policies of the company as explained in the Employee Handbook and its amendments from time to time, and to wear all personal protective equipment required for the occupation in which I am engaged. I agree to provide additional medical information which may be required or to take medical or any other type of examination (at the expense of the Company) necessary to qualify or retain employment with the company.Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, religion, national origin, disability, or any other factor protected by applicable law. Those applicants requiring reasonable accommodations to the application and or interview process should notify a representative of the Human Resources Department.I hereby acknowledge that I have read and fully understand the above certifications.Signature of Applicant* Date*
