R.O. Anderson Engineering, Inc.
Employment Application Form

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE	Please mail completed application to: 
R.O. Anderson Engineering, Inc.  
1603 Esmeralda Avenue  Minden, Nevada 89423
or fax application to:
775-782-7084	OFFICE USE ONLY:
Date received:
Reviewed by:

	
	
PLEASE COMPLETE PAGES 1-5.	DATE 		
Name 		
	Last 			First 			Middle 			Maiden	
Present address 		
			Number			Street		City	State	Zip	
How long at current address? _________________________		Social Security No. _______ –  _____  –  _________	
Telephone (      )	 	
If you are under 18 years old, can you furnish a work permit if required? ____YES ____N0
Are you currently authorized to work in the United States? ____YES _____NO.   Proof of eligibility will be required if hired.	

Position applied for  (1)	
and wage desired   (2) 	
(Be specific)	Days/hours available to work
No Pref.	 Thurs 	
Mon 	  Fri 	
Tue 	  Sat 	
Wed 	  Sun 		
How many hours can you work weekly? 	  	
Employment desired	FULL-TIME ONLY	  PART-TIME ONLY	    FULL- OR PART-TIME	
When are you available to start work?____________________________ 	

TYPE OF SCHOOL	NAME OF SCHOOL	LOCATION
(Complete mailing address)	NUMBER OF YEARS COMPLETED	MAJOR & DEGREE	
High School					
					
College					
					
Bus. or Trade School					
					
Professional School					

Have you ever been convicted of a crime? (Other than minor traffic violations)	  No	 Yes     (a Conviction record will not necessarily disqualify you from employment).	
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation. 		
	
____________________________________________________________________________________________________
____________________________________________________________________________________________________	

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE			
APPLICATION FOR EMPLOYMENT	

Note:  if driving is an essential job duty:	
Driver’s license 
number 	 State of issue  _______         Operator      Commercial (CDL)     Chauffeur	
Expiration date 		
Have you had any accidents during the past three years?	How many? 		
Have you had any moving violations during the past three years?	How Many? 		
	OFFICE POSITIONS ONLY		
	
	 Yes					 Yes		Word		 Yes
Typing	 No	   _____ WPM		10-key  	 No		Processing	 No	     _____ WPM	
Personal 	 Yes 	PC	 		
Computer	 No	Mac	 			Other 	
Skills 		
	
Please list two references other than relatives.	
Name 		Name 		
Position 		Position 		
Company 		Company 		
Address 		Address 		
						
Telephone  (      )		Telephone  (      )		
	
Please use this space to elaborate on any background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment.  You may include hobbies, volunteer experience and any other activities you believe relevant.  Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.	

	

	

	

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE			
APPLICATION FOR EMPLOYMENT	
	MILITARY		
	
HAVE YOU EVER BEEN IN THE ARMED FORCES?		 Yes	 No	
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?		 Yes	 No	
Specialty 	 Date Entered 	 Discharge Date 		
	
Work Experience	Please list your work experience for the past seven years beginning with your most recent job held.
If you were self-employed, give firm name.  Attach additional sheets if necessary.	
		
Name of employer 
Address	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From
To	Start
Final	
	Your last job title	
Reason for leaving (be specific)	
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.	

	

Name of employer 
Address	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From
To	Start
Final	
	Your Last Job Title	
Reason for leaving (be specific)	
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.	

	

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE			
APPLICATION FOR EMPLOYMENT	
Work experience	Please list your work experience for the past seven years beginning with your most recent job held.
If you were self-employed, give firm name.  Attach additional sheets if necessary.	
		
Name of employer 
Address	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From
To	Start
Final	
	Your last job title	
Reason for leaving (be specific)	
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.	

	

Name of employer 
Address	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From
To	Start
Final	
	Your last job title	
Reason for leaving (be specific)	
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.	

	

	
May we contact your present employer?	 Yes	 No	
Did you complete this application yourself	 Yes	 No   If not, who did? _______________________________	
After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied _____ Yes _____ No.  if you answered “No” , please identify those job functions that you cannot perform.  If a reasonable accommodation is required to enable you to perform the job properly and safely, please describe:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	

PLEASE READ CAREFULLY	

APPLICATION FORM WAIVER
As indication that you have read and understood each sentence, please write your initials in the spaces provided below.
	
In exchange for the consideration of my job application by R.O. Anderson Engineering, Inc., (hereinafter called “the Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment,____ or to confer any right to remain an employee R.O. Anderson Engineering, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned,____ and that relationship cannot be altered except by a written instrument signed by the Owner/Managing Member of the Company.____  Both the undersigned and R.O. Anderson Engineering, Inc. may end the employment relationship at any time, without specified notice or reason.____  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits._____	
I authorize investigation of all statements contained in this application.____  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.____  I hereby give the Company permission to contact schools, all previous employers (unless otherwise indicated), references and others and hereby release the Company from any liability as a result of such contact.____	
I further understand that my employment with the Company shall be probationary for a period of ninety (90) days and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party.____	

Signature of applicant__________________________________________ Date: ___________________ 

R.O. Anderson Engineering, Inc. is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with R.O. Anderson Engineering, Inc. depends solely on your qualifications.
	
	Thank you for completing this application form and for your interest in our business.