EMPLOYMENT Employment Please enable JavaScript in your browser to complete this form.1ABOUT YOU2YOUR WORK HISTORY3YOUR REFERENCES4YOUR EDUCATION5ADDITIONAL INFORMATIONName *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *NextEmployer 1Company *Date Employed *Date Employed *Phone *Final Wage *Type of work Performed *Reason of Leaving *Employer 2CompanyEmployment Date Employment Date PhoneFinal WageType of Work PerformedReason of leavingEmployment 3CompanyEmployment DateEmployment Date PhoneFinal WageType of Work PerformedReason of leavingHave you ever filed an application with us before? *YesNoAre you currently employed? *YesNoMay we contact your current employer? *YesNoAre you able to work overtime on a short notice? *YesNoDo you have a current and legally valid California State Driver's Licence? *YesNoCan you, before employment, submit verification of your legally right to work permanently in the United states? Please furnish the company with a copy of the same. *YesNoCan you perform the essential functions of the job you are being considered for? *YesNoAre you willing to work on a rotating basis, including Holidays and weekends? *YesNoAre you willing to attend educational seminars? *YesNoHave you been convicted of an indictable offence or been convicted of any disorderly persons or local ordinance violations during the last seven [7] years? *YesNoIf yes, Please provide details(Criminal convictions are not an automatic bar to employment but will only be considered in relation to a specific job)Do you have any other commitments that would interfere with this job? *YesNoIf yes, Please provide detailsPosition For Applying *Expected Rate of pay *Available Start Date *Are you at least 18 years of age? *YesNoPersonal InformationReferred By: (Please check applicable box and specify if other sources) *AgencySchoolNewspaperInternet SiteOthersPlease SpecifyAre you willing to take a drug test? *YesNoDo you have a valid driver’s license? *YesNoIssuing State * License # *Exp. Date *Any traffic violations within the last three years?Briefly describe the reason you want to leave your present place of employment, if applicableList any professional, trade, business or civic activities and/or offices held relative to your ability to perform the job to which you are applying.List any/all certificates and/or licenses that you possess related to the job for which you are applying.PreviousNextReference 1NamePhoneRelationshipReference 2NamePhoneRelationshipReference 3NamePhoneRelationshipPreviousNextHigh School Name *Location *Years completed *Did You Graduate? *YesNoWhat year Did you graduate? *Degree? *Trade SchoolSchool NameLocationYears CompletedCourse of studyDid You Graduate?YesNoWhat year Did you graduate?Degree?Other SchoolSchool NameLocation Course of studyDid You Graduate?YesNoWhat year Did you graduate? Degree? PreviousNextList of any information that you feel may be helpful to us in considering you application:Where do you see yourself five years from now?Are you interested in money, or just doing your job well?Share an event that has occurred in your life within the last five years and how it had a significant impact on your life.All companies judge an employee's performance against certain standards and benchmarks. What standards or benchmark do you think should be used to judge you and why?PreviousSubmit 24/7 Emergency Service ● Free Estimates ● Flat Rate Pricing Main Office 562-925-2838 Orange County 714-994-0254 Email us info@rpbinc.com