RLO Employment Application

GENERAL INFORMATION… (NOTE: All fields are required. If it doesn't apply, simply put N/A or 0 (zero) )

First Name

Middle Initial

Last Name

Email Address

Primary Contact Phone

Secondary Contact Phone

Street Address

Address Line 2

City

State

Zip

-

How long at this address?

Years Months

Previous Address
City, State. Zip

How long there?

Years Months

POSITION/EMPLOYMENT INFORMATION …

Position you are applying for

Salary Desired

$

Date available for work (mm/dd/yyyy)

/ /

Referred by

Do you have reliable
transportation to work?

YES .............. No

Are you 18 or older?

YES .............. No

Are you legally authorized to work
in the United States?

YES .............. No

Are you willing to transfer/relocate?

YES .............. No

Are you willing to travel?

YES .............. No

How did you learn of this opening?

Have you ever been
employed by RLO before?

YES .............. No

If so, when were you last employed by RLO? (mm/dd/yyyy)

/ /

Position Held

Total hours available per week

Hours or shifts or days you can not
or will not work?

Preferred Shift:

Part Time... Full Time...

Willing to work overtime as required?

YES .............. No

After reviewing the job overview for the position you are applying for: Do you have any physical or mental condition which would limit your capacity for the job?

YES .............. No

If yes to the above, what can be done to accomodate your situation?

EDUCATION INFORMATION…

School Name, City & State	Did you graduate? (Yes/No)	Degree/Courses	G.P.A.
High School
College
Graduate School
Other

TECHNICAL SKILLS/EQUIPMENT KNOWLEDGE…

Computer Skills (Experience)

Microsoft Windows XP

YES .............. No

Macintosh OS-X

YES .............. No

Computer Scanner

YES .............. No

Typing Speed: WPM

Touch ........... Sight

10-Key Calculator Speed: NPM

Touch ........... Sight

Comments:

OFFICE/SOFTWARE SKILLS…

Program/Application

Skill Rating (1 = Begininner or not applicable)

Microsoft Excel

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Microsoft Word

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Microsoft Outlook/Outlook Express

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Quark Xpress

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Filemaker

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Please list in spaces below any other software application you may be familiar with

Other application:

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Other application:

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Other application:

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Other application:

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Other application:

1 (Beginner) ... 2... 3... 4... 5 (Adept Expert)

Office Equipment

Adding Machine

YES... NO...

Shredder

YES... NO...

Fax Machine

YES... NO...

Postage Machine

YES... NO...

Typewriter

YES... NO...

Multi-line Phone

YES... NO...

Labeling Machine

YES... NO...

High-Speed Copier

YES... NO...

Binding Equipment

YES... NO...

Others

EMPLOYMENT BACKGROUND… (most recent first)

List below your three most recent employers, beginning with the current or most recent one. If you were employed under a maiden or other name, please enter that name in the right hand margin.

May we contact your present employer?

YES... NO...

JOB ONE:

Business Name:

Address:

Job Title:

Name of Supervisor:

Phone:

Date Started: Date Left:

Base Salary or Wage:

Start: $

End: $

Bonus: $

Reason for Leaving:

JOB TWO:

Business Name:

Address:

Job Title:

Name of Supervisor:

Phone:

Date Started: Date Left:

Base Salary or Wage:

Start: $

End: $

Bonus: $

Reason for Leaving:

JOB THREE:

Business Name:

Address:

Job Title:

Name of Supervisor:

Phone:

Date Started: Date Left:

Base Salary or Wage:

Start: $

End: $

Bonus: $

Reason for Leaving:

During the past 5 years, have you ever been convicted of, pled guilty to
or pled no contest to: a crime, excluding misdemeanors and traffic violations?
(a conviction will not necessarily bar you from employment)

YES... NO...

If yes, describe in full:

Reference Name, Address and Phone:

Reference Name, Address and Phone:

Reference Name, Address and Phone:

Thank you for taking time to complete our online employment application.
Below is our APPLICANT CERTIFICATION AND AGREEMENT.
Please review the clauses carefully and indicate your acknowledgement where indicated

PLEASE READ CAREFULLY THE SECTION BELOW BEFORE AGREEING. 1. I certify that I have read this application and the information on it is complete and correct. I understand that any omissions or misrepresentation of information is grounds for dismissal. 2. I authorize the persons, employers, schools and organizations listed on this application to give you any information concerning my employment and other pertinent information they may have, personal and otherwise, and release all parties from all liability and damages that may result from furnishing this to you. 3. I acknowledge that I am applying for employment with an independently owned and operated company. 4. I acknowledge that the owner of this company reserves the right to amend or modify any of its handbooks or policies at any time and without prior notice. These policies do not create any promises or contractual rights between this employer and its employees. At this independently owned and operated company, employment is at will. This means an employee is free to terminate his/her employment at any time, without any reason, with or without cause, and the franchise owner retains these same rights. The owner of this independently owned and operated company is the only person who may make an exception to this, and any exception must be in writing, addressed to a particular individual, and signed by the owner. 5. R. L. O'Connor & Associates, Inc. is an Equal Opportunity Employer. Various federal, state, and local laws prohibit discrimination on account of race, color, religion, sex, age, national origin, disability or veterans status. It is this company's policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law. 6. I understand that as a part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation, personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the name and address of the reporting agency that supplies the information.

By typing YES in this box, I agree that all of the above information is accurate.

Today's Date / /

An Equal Opportunity Employer

This company is an equal opportunity employer committed to a diverse work force. In order to assist us in our efforts, we invite you to voluntarily provide responses to the following requests for information. Failure to respond will not subject you to adverse treatment. This information shall be kept confidential and separate from your application. Information provided will be used only in accordance with the law and for equal opportunity purposes.

Below is our NON-DISCLOSURE AGREEMENT.
Please fill in the date and your name in the areas indicated. Then indicate whether or not you agree to the terms of the NON-DISCLOSURE AGREEMENT or not. If you disagree, the application will not be accepted.

THIS AGREEMENT is enterred into this day of , 20 , between (applicant) and R. L. O'Connor & Associates, Inc.

In consideration of the mutual promises and covenants contained herein, the parties agree as follows: Provided Interviewer and Applicant execute this agreement and as a condition precedent, R. L. O'Connor & Associates, Inc. authorizes Interviewer to disclose certain confidential, proprietary and trade secret information to Applicant. Applicant agrees, as a condition precedent to discussing with R. L. O'Connor & Associates, Inc. and any of its representatives the establishment of a business relationship between the parties, that Applicant will not disclose to any other person or entity any confidential, proprietary, or trade secret information disclosed to him/her during such discussion. Applicant acknowledges that this agreement was reached prior to any disclosure to him of proprietary, confidential, or trade secret information and further understands and agrees that it shall be enforced by either the Interviewer or R. L. O'Connor & Associates, Inc.

I have read and understand this non-disclosure agreement
and understand I will be required to sign a physical copy (type YES):

© 2005-Present R. L. O'Connor & Associates, Inc.
2505 S. 320th Street, Ste. 640 • Federal Way, WA 98003-5473
Phone: 800.755.0988 Fax: 253.946.9131
E-mail: careers@rloconnor.com