This is a generic RPM Automotive application form and is used for all positions. Many of the jobs available at RPM require substantial physical activity. Applicants must be in good physical condition in order to perform the duties expected. Additionally, applicants for some positions must meet specific age requirements. This is due to insurance limitations and the regulations. Please complete all sections necessary for the positions that you are applying for. Feel free to leave any section blank that does not apply. All positions are subject to random drug testing.
Applicant's Name:
Address:
City/State/Zip:
Home Phone #:
Work Phone #:
Email Address:
Social Security #:
List your job you are applying for:
1) Please describe why you are interested in working for our company:
2) Based on the position you are interested in, describe your previous relevant experience:
3) List any of your talents, skills, licenses, etc. that will be valid through September 2007, which may be of value to our company:
4) Have you ever been convicted of any crime (excluding minor traffic violations) including driving under the influence of drugs or alcohol?
If yes, describe:
YesNo
5) How long have you been a licensed driver? (Years / Months)
6) Do you have a Driver's License?
If no, are you willing to acquire one?
YesNo
YesNo
7) What is the dates you will be available for employment ?
Is there any reason these dates may change? If yes, please explain:
Start:
YesNo
8) If relocating for the job, will you have sufficient funds to support yourself until your first paycheck? (Usually 30 days)
YesNo
9) RPM may be arranging Medical Insurance for its Employees. Are you interested in this assistance? (Fee’s will be deducted from your paycheck)
YesNo
10) Who should be contacted in case of emergency:
Name:
Address:
City, State, Zip:
Home Phone:
Work Phone:
11) Are there any days or hours you would be unable or unwilling to work? If yes, please list:
YesNo
12) Please provide a personal references:
Name:
Home Phone:
Address:
City, State, Zip:
EMPLOYMENT HISTORY
13) Please provide information from your three most recent employers. *Note: Applications with complete and accurate information (phone numbers, etc.) will be given priority.
(1) Business:
Supervisor Name:
Title:
Daytime Phone:
May we contact?
Yes No
List Position/ Duties:
Employed From:
To:
Ending Salary:
Year Month Hour
Reason for leaving:
(2) Business:
Supervisor Name:
Title:
Daytime Phone:
May we contact?
Yes No
List Position/ Duties:
Employed From:
To:
Ending Salary:
Year Month Hour
Reason for leaving:
(3) Business:
Supervisor Name:
Title:
Daytime Phone:
May we contact?
Yes No
List Position/ Duties:
Employed From:
To:
Ending Salary:
Year Month Hour
Reason for leaving:
14) How much time have you spent in doing this line of work?
15) Do you have tools?
If yes, what kind?
Yes No
16) Do you have First Aid?
If yes, which of the following do you have?
Yes No
CPR Basic Advanced EMT
17) Pay rates have been established for all positions. Please list the minimum earnings you would require to consider employment with RPM. We will try to offer only positions that exceed your minimum earning requirement.
I must earn $ per Hour.
18) Please check the highest level of education completed or years attended:
Junior High High School College Post College Other
*Note: The following questions are not criteria for employment for all jobs, but many positions require substantial physical effort or have minimum age requirements.
19) What physical activities do you participate in on a regular basis?
20) Some positions require physical exams and/or drug screening. Are you willing to take both if required?
Yes No
21) Have you ever been injured on the job?
If yes, please list nature and cause of the injury, date and employer:
Yes No
22) Do you have any physical limitations or conditions that would restrict your ability to perform strenuous physical labor?
