Employment Application

Please read and answer all of the following questions. No action can be taken on your application until all questions have been answered and the application is signed. None of the questions are intended to imply discrimination or illegal preferences based upon non-job related information.
It is the policy of Restoration Relief that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, and gender, national origin, age, veteran status, the presence of a non-job related medical condition or disability.

Personal Information

First Name

Last Name

Address

City

State

ZIP/Postal Code

Phone

How were you referred to Restoration Relief?

Introduction

Start Date

Salary Desired

Position Applying For

Are you a citizen of the United States?

Are you authorized to work in the U.S.?

May we contact your present employer?

Do you have any friends/relatives employed with this Company?

If yes, please list name of friend or relative

Are you capable of performing the essential functions of the job for which you are applying with reasonable accommodation?:YesNo

If no, please describe

Have you ever applied here before?

If yes, when have you applied before?

Have you ever been convicted of a felony?

If yes, please explain your felony?

*NOTE. Disclosure of a criminal record will not necessarily disqualify you from employment, as the nature of the offense, date, and the position for which you are applying will also be considered.

Education/Skills

High School

Name & Location

Years Attended

Did you graduate?

Subjects Studied/Degree

College

Name & Location

Years Attended

Did you graduate?

Subjects Studied/Degree

Trade or Business

Name & Location

Years Attended

Did you graduate?

Subjects Studied/Degree

Skills/Other

Special Training

Special Skills

Previous Employment

From

Name & Address of Employer

Phone

Supervisor

Salary

Position

Reason for Leaving

May we contact your previous supervisor for a reference?

From

Name & Address of Employer

Phone

Supervisor

Salary

Position

Reason for Leaving

May we contact your previous supervisor for a reference?

From

Name & Address of Employer

Phone

Supervisor

Salary

Position

Reason for Leaving

May we contact your previous supervisor for a reference?

Driving History

Do you currently have a valid driver’s license?

If yes, in what State/County?

License Class:

Have you had your driver’s license suspended or revoked in the past three (3) years?

If yes, please explain:

References

Name

Business

Address

Relationship

Phone Number

Name

Business

Address

Relationship

Phone Number

Name

Business

Address

Relationship

Phone Number

Military Service

Branch

Served From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Special Skills Learned

Resume

Attach Resume

Employment Notices

Pre-Employment Physical Testing Notice

Restoration Relief is committed to maintaining a drug-free workplace. Therefore, all candidates for
employment (applicants to whom a contingent offer of employment has been made) are required to complete a testing for drug and alcohol use, by a physician of the Company’s choice. Employment is contingent upon a candidate's submission to and successful completion of the drug/alcohol test.

Applicant's Acknowledgement

I agree to undergo the pre-employment drug/alcohol test. I understand that the results of such a test will be disclosed only to the Company’s Human Resources personnel and other's with a need to know or as required by law. I understand that if I refuse to consent to testing, fail to provide a test sample when requested, provide a false or tampered sample, or fail to successfully complete the drug/alcohol test, I will not be hired.

Permission is granted to Restoration Relief to conduct an investigation and to solicit information as to my Educational and employment history, character and general reputation, and criminal conviction record. I release Restoration Relief and all persons or organizations from any liability arising from such statements, their solicitation or use.

I understand that as a condition of employment I must be authorized to work in the United States and demonstrate that authorization as required by the Immigration Reform and Control Act of 1986.

I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause. If terminated, I authorize Restoration Relief to deduct, to the extent permitted by law, any amount which I may owe to it from any amount which Restoration Relief may owe me. I understand that no representative of Restoration Relief has any authority to offer or to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.

I certify that all statements made by me on this application are true and correct to the best of my knowledge and belief. I understand that any false, inaccurate, or omitted statements of a material fact could be a cause for rejection of my application or termination of my employment at any time.

I have read, understand and by my signature consent to these statements.

Date

Electronic Signature

By submitting this application, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.