RDI APPLICATION

Personal Information

Last Name*:

First Name*:

Middle Name:

Address*:

City*:

State*:

Zip Code*:

Social Security Number*:

Date of Birth*:

Phone Number*:

Work Phone Number:

Are you age 16 or over? Yes No

Over 18? Yes No

Have you worked for RDI in the past? Yes No

If yes, which department:

If related to anyone at this company, state name:

and department:

Referred by:

Position

Position:

Location:

Date you can start:

Are you employed? Yes No

If so, may we inquire of your present employer? Yes No

	Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.	Sun
Available to work:

Education

	Name & Location of School	Number of Years Attended	Graduated
High School			Yes No
College			Yes No
Trade/Business Technical			Yes No

List the skills/aptitudes you have that would be useful in the position you are seeking:

Work History

Month & Year

Name/Address of Employer

Title:

Responsibilities

From:

To:

Reason for Leaving:

Salary:

Month & Year

Name/Address of Employer

Title:

Responsibilities

From:

To:

Salary:

Please elaborate on those responsibilities that would be useful to you in the position for which you are applying.

If employed, reason for leaving present employer.

Have you ever been dismissed or forced to resign from any employment? Yes No

In order to check your past employment and education history, have you previously used a different name? Yes No

If "Yes" identify name and date of use:

Have you been convicted of a felony? Yes No

If "Yes" please describe in full:
(Conviction will not necessarily disqualify an applicant from employment):

Have you been convicted of a misdemeanor? Yes No

If "Yes" please describe in full:
(Conviction will not necessarily disqualify an applicant from employment)

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? Yes No
(Proof of employment eligibility will be required upon employment.)

Do you have any physical condition(s) which may limit your ability to perform the job for which you are applying? Y N

If "Yes" describe the condition(s) and explain the work limitations:

Agreement

I authorize investigation of all statements made in this application and release from all liability all persons or corporations requesting or supplying any information. I understand and agree that no commitment for any specific duration, including lifetime employment, has been made and none shall be valid or binding on the company. If employed, I am free to leave employment at any time for any reason satisfactory to me and the company may terminate my employment at any time for any reason satisfactory to it. Any policies, procedures, rules or regulations upon which I may rely may be changed from time to time, interpreted, withdrawn or added to by the company at any time. I further understand and agree that no representative of the company, other than the president, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing, and not unless the president does so in a written document signed by me and the president of the company.

Name*:

I agree with the above statement

Select Resume to upload:

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