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All fields that are in bold lettering are required information.
Personal Information
Last Name
:
First Name
:
Middle Name:
Position Applying For
Position:
Contact Information
Street
:
City
:
State
:
Zip Code
:
Phone
#:
Mobile #:
Email Address:
If necessary, the best time to call you at home:
Please list the appropriate name and the source.
Walk-in:
Revere Employee:
Revere Customer/Vendor:
Advertisement:
Company's Website:
School:
Job Fair:
Staffing Agency:
Government Employee Agency:
Other Internet:
Other:
May we contact you at work?
Yes
No
If
yes
, please fill out next two fields.
Work #:
Best Time:
Are you under 18 years old?
Yes
No
Have you applied for a job here before?
Yes
No
If
yes
, please fill out next two fields.
Date(s):
Position(s):
Have you worked here before?
Yes
No
If
yes
, please fill out next two fields.
Start Date:
End Date:
Are you legally eligible to work in this country?
Yes
No
Date available
:
Desired Salary:
Type of employment desired?
Full-Time
Part-Time
Educational Co-op
Seasonal
Temporary
Are you willing to relocate if job requires it?
Yes
No
Will you travel if job requires it?
Yes
No
If YES select amount
25%
50%
75%
100%
Will you be willing to work overtime if required?
Yes
No
If
No
Explain:
Have you ever been bonded?
Yes
No
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Yes
No
If
Yes
Explain:
Have you entered into an agreement with any former employer or other party (such as non-competition agreement) that might, in any way, restrict your ability to work for our company?
Yes
No
If
Yes
Explain:
Starting with your most recent employer, please provide the following information.
Employment History - 1
Notice
Fill in your employment start and end dates.
Start (Month/Year):
End (Month/Year):
Employer:
Telephone #:
Street Address:
City:
State:
Starting job title:
Final job title:
For final job:
Supervisor Name:
Supervisor Title:
Compensation (Starting)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Compensation (Final)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about your position?
Why did you leave?
Employment History - 2
Notice
Fill in your employment start and end dates.
Start (Month/Year):
End (Month/Year):
Employer:
Telephone #:
Street Address:
City:
State:
Starting job title:
Final job title:
For final job:
Supervisor Name:
Supervisor Title:
Compensation (Starting)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Compensation (Final)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about your position?
Why did you leave?
Employment History - 3
Notice
Fill in your employment start and end dates.
Start (Month/Year):
End (Month/Year):
Employer:
Telephone #:
Street Address:
City:
State:
Starting job title:
Final job title:
For final job:
Supervisor Name:
Supervisor Title:
Compensation (Starting)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Compensation (Final)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about your position?
Why did you leave?
Employment History - 4
Notice
Fill in your employment start and end dates.
Start (Month/Year):
End (Month/Year):
Employer:
Telephone #:
Street Address:
City:
State:
Starting job title:
Final job title:
For final job:
Supervisor Name:
Supervisor Title:
Compensation (Starting)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Compensation (Final)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about your position?
Why did you leave?
Employment History - 5
Notice
Fill in your employment start and end dates.
Start (Month/Year):
End (Month/Year):
Employer:
Telephone #:
Street Address:
City:
State:
Starting job title:
Final job title:
For final job:
Supervisor Name:
Supervisor Title:
Compensation (Starting)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Compensation (Final)
Hourly
Salary
$:
Per
Select Option
Year
Hour
Other
Commission/Bonus/Other Compensation:
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about your position?
Why did you leave?
Employment Details
Explain any gaps in your employment, other than those due to personal illiness, injury, or disability.
Have you ever been fired or asked to resign from a job?
If
YES
please explain:
Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.
Starting with your most recent school attended, please provide the following information.
Education Background - 1
School Name (City & State):
Years Completed:
Degree Type:
Major/Minor:
GPA/Class Rank:
Education Background - 2
School Name (City & State):
Years Completed:
Degree Type:
Major/Minor:
GPA/Class Rank:
Education Background - 3
School Name (City & State):
Years Completed:
Degree Type:
Major/Minor:
GPA/Class Rank:
References
List names and telephone numbers of 3 business/work references, who are
not
related to you. If not applicable, list school/personal references that are
not
related to you.
Reference - 1
Name:
Title:
Relationship to you:
Telephone #:
Years Known:
Reference - 2
Name:
Title:
Relationship to you:
Telephone #:
Years Known:
Reference - 3
Name:
Title:
Relationship to you:
Telephone #:
Years Known:
More Details
Is there any other job-related information you want us to know about you?
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.
I express authorize, without reservation, the employer, its representatives or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations and organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be neccessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
The Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory prictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.