ROCS | Job Application

APPLICATION FOR EMPLOYMENT

Applications are considered for all positions without regard to race, color, religion, sex, national origin, age or handicap. This application will remain active for 60 days. To be considered after 60 days will require filling out another application.

Position Applied For:

Estimated Start Date:

PERSONAL INFORMATION

First & Last Name:

Email:

Phone Number:

Address:

EMPLOYMENT HISTORY

Start with your CURRENT or most recent job.

Job Title:

Employer

Start Date

End Date

Starting Wage

Ending Wage

Type of Business

Employer Address

Supervisor Name & Title

Supervisor Phone Number

Average Weekly Hours Worked

Reason for leavng

Duties Performed

Job Title:

Employer

Start Date

End Date

Starting Wage

Ending Wage

Type of Business

Employer Address

Supervisor Name & Title

Supervisor Phone Number

Average Weekly Hours Worked

Reason for leavng

Duties Performed

Job Title:

Employer

Start Date

End Date

Starting Wage

Ending Wage

Type of Business

Employer Address

Supervisor Name & Title

Supervisor Phone Number

Average Weekly Hours Worked

Reason for leavng

Duties Performed

EDUCATION & TRAINING

The information provided on the following pages will be used to determine your qualifications for this position.

Name of High School

City, State

Highest level of education completed

College/University/Trade School

Degree/Certification

List any special skills or qualifications

Describe special training, skills, extra-curricular activities, workshops & internships

List additional work or volunteer activities that have provided you with skills/qualifications for this position

REFERENCES

Please provide 3 professional references.

#1 Reference - First & Last Name

Job Title

Email / Phone

#2 Reference - First & Last Name

Job Title

Email / Phone

#3 Reference - First & Last Name

Job Title

Email / Phone

PLEASE READ BEFORE SIGNING

I understand and agree that by signing this application:

I am certifying that the information is true, correct and complete to the best of my knowledge and belief. I understand that misrepresentations, falsifications, or omission of facts called for in this application is cause for cancellation of this application or termination of employment.
I authorize the investigation of all statements I have made in my application for employment, related papers, and oral interviews concerning past work history and education. I am releasing from liability any person giving or receiving such information.
I understand this is an application for employment and that no employment contract is being offered.
In the event of my employment, I will comply with all agency rules and regulations set forth in the agency's Personnel Policies and Procedures Manual or other communications distributed to all employees.
I understand that, if I am employed, such employment is for no definite period of time and Rural Office of Community Services, Inc. can change wages, benefits, and conditions at any time.

I agree to the above statements and attest that all information provided is true to the best of my knowledge.

Your Signature

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Thank you! We’ll be in touch.

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Equal Employment Opportunity & Affirmative Action Statistics

Rural Office of Community Services is an equal opportunity employer. The attached information is requested for statistical and affirmative action purposes and in no way influences employment prospects. It is separated from your application immediately. This information is maintained confidentially and is not available to any employing agency. Your responses are voluntary.

Postion applied for

Name

Date

Address

Your Signature

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT HISTORY

EDUCATION & TRAINING

REFERENCES

Upload resume:

* This section is optional*

Equal Employment Opportunity & Affirmative Action Statistics

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