Submit Job Application
Pre-Employment Questionnaire - All application sections are required fields. Richland Glass is an Equal Opportunity Employer.
First, Middle & Last Name:
Social Security Number (SSN):
Present Address:
City: State: Zip:
Permanent Address:
Cell Phone:
Home Phone:
Email:
Are you 18 years or older?
Yes No
-
Position:
Date you can start:
Salary Desired:
If so, may we inquire of your present employer?
Have you ever applied to this company before?
If so, Where?
When?
Referred By:
List Below the Last Three Employers, Starting with the last one first.
Date (Month & Year):
Employer Name & Address:
Salary & Position:
Reason for Leaving:
From: To:
$
Which of these jobs did you like best?
What did you like most about this job?
Subjects of Special Study or Research Work:
Special Skills:
Activities: (Civic, Athletic, Etc. - NOTE: exclude Organizations the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members).
U. S. Military or Naval Service:
Rank:
Present Membership in National Guard or Reserves:
Give the names of three persons not related to you, whom you have known at least one year.
Name:
Address:
Business:
Years Acquainted:
The following applies in: Maryland & Massachusetts (Fill in the name of the state below) It is unlawful in the state of Select State Maryland Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. By checking this box, you acknowledge the above statement. Please check here if you filled in a state above.
IN CASE OF EMERGENCY NOTIFY:
Work #:
Home/Cell #:
PLEASE READ CAREFULLY: "I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."
I have read and understand the statement above. Enter today's date:
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.
