Employment Application
Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, or handicap.
Personal Information
First Name
Last Name
Middle Initial
"Nickname"
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Home Phone
Email Address
Social Security #
Office Location
Desired Branch
Peoria
Galesburg
Moline
Peru
Position Desired
Select Department
Sales Representative
Other
Pay Expected
Date Available to Begin Work
Are you on layoff and subject to recall?
Yes
No
Are you at least 18 years of age?
Yes
No
Are you available for full-time?
Yes
No
If not, what hours can you work?
Will you work overtime if asked?
Yes
No
Are you legally eligible for employment in the United States? (Proof is required)
Yes
No
Special training or skills?
How did you learn of our organization?
Referred by
Have you ever worked here before?
Yes
No
If so, when?
Name/Department of any relatives employed by Royal Publishing
Emergency Contact
Phone
Address
Education History
High School
School Name
School Location
Course of Study
Years Completed
Did you graduate?
Yes
No
Degree or Diploma
College
School Name
School Location
Course of Study
Years Completed
Did you graduate?
Yes
No
Degree or Diploma
Other
School Name
School Location
Course of Study
Years Completed
Did you graduate?
Yes
No
Degree or Diploma
Previous Employment
Please give accurate, complete information, starting with your present or most recent employer.
Company Name
Address
Phone
Supervisor Name
Employed From (Month & Year)
To
Job Title & Work Description
May we contact?
Yes
No
If not, why?
Reason for leaving
Second Employer
Company Name
Address
Phone
Supervisor Name
Employed From (Month & Year)
To
Job Title & Work Description
May we contact?
Yes
No
If not, why?
Reason for leaving
Third Employer
Company Name
Address
Phone
Supervisor Name
Employed From (Month & Year)
To
Job Title & Work Description
May we contact?
Yes
No
If not, why?
Reason for leaving
References
List three persons not related to you whom you have known for at least one year.
Name
Address
Phone
Business
Years Acquainted
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30+
Second Reference
Name
Address
Phone
Business
Years Acquainted
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30+
Third Reference
Name
Address
Phone
Business
Years Acquainted
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30+
Signature
Read carefully and check each box to agree to the following statements, then sign, and date.
I certify that the information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal or at the Company's sole option, my being placed in another position. I also understand that misstatements or omissions of fact in this application or in my interview will be a basis for my not being hired.
I understand that acceptance of an offer of employment by the Company that my employment does not create a contractual obligation upon the employer to continue to employ me in the future. I further understand that if I am employed by the Company that my employment will be "at will" and that no representations as to the term or the conditions of my employment have been made to me by the Company or any of its representatives.
I authorize the Company to request and receive all information relating to me in order to review my education, previous employment, driving, criminal records, and any other background data.
I understand that as a condition of my employment I may be required to submit to drug or alcohol testing and that either my refusal to participate in such a test or the results indicative of positive use may be grounds for my immediate dismissal or (if applicable) the basis for my not being hired.
Signature
Date
When finished, click here to submit your application.
Submit