Email Address

Last School Attended

City / State

Last Grade Completed

City / State

Degree

Certifications/Licenses, Etc.

Position Desired

Date Available

Minimum Salary

If yes, please explain:

Why do you want to work for RSI?

REFERENCES

Reference 1

Name: Phone: Address: Business: Years Known:

Reference 2

Name: Phone: Address: Business: Years Known:

Reference 3

Name: Phone: Address: Business: Years Known:

EMPLOYMENT HISTORY

Current or Most Recent Employer

Address

Phone

Job Title

Supervisor

Dates of Employment

Wage Start / Final

Reason for leaving

Describe duties

Next Most Recent Employer

Address

Phone

Job Title

Supervisor

Dates of employment

Wage Start / Finish

Reason for leaving

Describe duties

If yes, please indicate

Please explain any gaps in your last 5 years of employment of more than 3 months:

AGREEMENT & SIGNATURE

My signature below certifies that I have completed this application honestly and all information is true and correct. I understand that it is RSI's right to check references and former employers to inquire about my work hisory and work ethics. I authorize all references, former employers, credit agencies, educaional institutions, law enforcement agencies, city, state, and federal courts as well as military services to release information about my background. I understand that an inquiry into my background will be made before any employment offer is made. Any misrepresentation or omission of any facts in my application, resume, or other materials can be justification for refusal of employment, or if employed, termination. I also understand that if an offer of employment is made, I am willing to submit to a criminal background check. I also understand my employment and compensation can be determined with or without cause or notice, at any time, at the option of either the company or myself. Finally, I understand this application is not an offer of employment.

Signature

Date

APPLY @ RSI