Apply Now - Rock Industries

Position You Are Applying For?*

Personal Details

Name*

First Middle Last

Contact Details

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

High School

School Name*

School City/State*

City State

Diploma*

College / Technical School

School Name*

School City/State*

City State

Diploma*

Degreee/Certification/Area of Study*

Employment Information

Proposed Starting Date

Status Preference

Shift Preference

How Did You Hear About Rock Industries?

Please Answer the Following Questions

Are You At Least 18 Years of Age?*

Are You Authorized to Work in the United States?*

Have You Been Convicted of Any Misdemeanors or Felonies in the Past 5 Years?*

If Yes, Please Explain

Have You Used Names Other Than the One Provided?*

If Yes, Please Explain

Employment History

May We Contact Your Current or Most Recent Employer?*

Current / Most Recent Employer

City/State/Zip

City State / Province / Region ZIP / Postal Code

Phone

Position Held

Date Range

Supervisor

Duties

Pay Upon Leaving

Reason for Leaving

Current / Most Recent Employer

City/State/Zip

City State / Province / Region ZIP / Postal Code

Phone

Position Held

Date Range

Supervisor

Duties

Pay Upon Leaving

Reason for Leaving

Please Explain Any Gaps in Your Employment History

Job-Related Skills

Please List Any Additional Work Related Skills And/Or Experiences

References

Please list 2-3 references that can be contacted.

Name*

First Last

Relationship

Years Known

Phone

Additional Information

Name*

First Last

Relationship

Years Known

Phone

Additional Information

Name*

First Last

Relationship

Years Known

Phone

Additional Information

Signature*

Application Certification Agreement

1. I certify that the information provided by me is to the best of my knowledge complete and tru. I understand that any false information, omissions or misrepresentations of facts called for in the application may result in rejection of my application or discharge at any time during my employment.

2. I authorize Rock Industries and/or it’s agent, including consumer-report bureaus, to verify any of the information I have provided. I authorize former employers, persons, schools, complanies and law enforcement authorities to release any information concerning my background and release all such persons and organizations from all liability brought forth by any investigation resulting from my submission of this application and the data contained herein.

3. I understand that the use of controlled substances is prohibited during employment. I am willing to submit to drug/alcohol testing to detect the use of illegal drugs prior to and during employment.

4. I understand that this application or the acceptance of the same does not constitute an employment contract of any kind. I understand and agree that if employed, my employment will be “at will.” That is, either Rock Industries or I may end the employment relationship at any time for any reason or for no reason.

5. I understand the by signing or typing my name in the signature line below and submitting this application I am verifying my understanding of, and agreement of the above.

First Last

Date*