RFMS Employment Application RFMS Application for Employment Step 1 of 5 - Personal Information 20% Today's Date: Date Format: MM slash DD slash YYYY Position Applying For:*Applicant Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneMobile PhoneEmail Address* Check all that apply:* Full Time Part Time Date Available:* Date Format: MM slash DD slash YYYY Salary Desired*Are you at least 18 years or older?* Yes No Are you legally eligible for employment in the United States?* Yes No (If offered employment, you will be required to provide documentation to verify eligibility.)Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?* Yes No Please indicate education or training in which you believe qualifies you for the position you are seeking.High School: No. of Years Completed (select one)*1234High School Diploma?* Yes No G.E.D?* Yes No School(s), City State*College and/or Vocational School: No. of Years Completed (select one)*1234College(s), City State*College Major:*Degrees Earned:*Do you have other training or degrees?YesNoOther Training or Degrees, City State*Relevant Course(s)Degree or Certificate Earned Professional Licenses Held:Other Professional Memberships:(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)Have you ever been employed at RFMS, Inc.?* Yes No Dates EmployedPositionHow did you learn about this position?*Do you know anyone who works for RFMS?* Yes No Name(s) of RFMS employee(s) who you know:Have you been referred by anyone currently working at RFMS?* Yes No Name(s) of RFMS employee(s) who referred you? May we contact your present employer?* Yes No If employment was under a different name, indicate name:Current Employer Name:*Current Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Employer Phone:*Current Position:*Current Dates of Employment*Enter from and to dates.Current Supervisor:*Current Department:*Current Duties:*FT/PT* Full-time Part-time Current Number of Hours Worked per Week*Reason for Leaving Current Position:*Do you have additional employers to list?YesNoPrevious Employer NamePrevious Employer Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Employer Phone:Previous Position:Previous Dates of EmploymentEnter from and to dates.Previous Supervisor NamePrevious DepartmentPrevious Duties:FT/PT Full-time Part-time Previous Number of Hours Worked per WeekReason for Leaving:Do you have additional employers to list (2)?YesNoPrevious Employer NamePrevious Employer Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Employer Phone:Previous Position:Previous Dates of EmploymentEnter from and to dates.Previous Supervisor Name:Previous Department:Previous Duties:FT/PT Full-time Part-time Previous Number of Hours Worked per WeekReason for Leaving:Do you have additional employers to list (3)?YesNoPrevious Employer NamePrevious Employer Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Employer Phone:Previous Position:Previous Dates of EmploymentEnter from and to dates.Previous Supervisor Name:Previous Department:Previous Duties:FT/PT Full-time Part-time Previous Number of Hours Worked per WeekReason for Leaving:If you wish to describe additional work experience, furnish the above information for each position as an attachment to this application form submission.Do you have any gaps in employment?*YesNoExplain any gaps in work history:*Have you ever been discharged from a job?* Yes No If yes, explain: REFERENCES: Professional #1 - Name*Please describe the professional association with reference #1.*Reference #1 Email Enter Email Confirm Email Reference #1 PhoneREFERENCES: Professional #2 - Name*Please describe the professional association with reference #2.*Reference #2 Email Enter Email Confirm Email Reference #2 PhoneREFERENCES: Professional #3 - Name*Please describe the professional association with reference #3.*Reference #3 Email Enter Email Confirm Email Reference #3 PhoneAre you subject to a non-compete or any other professional agreement that affects your eligibility as an applicant?*YesNoUnsureApplicant's Certification and Agreement - Enter your initials to certify and agree:*APPLICANT'S CERTIFICATION AND AGREEMENT I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize RFMS, Inc. to verify their accuracy and to obtain reference information on my work performance. I hereby release RFMS, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause. This application for employment is good for 30 days only. Consideration for employment after 30 days requires a new application.Upload Your Resume (optional):Accepted file types: pdf.Please upload PDF files only.Upload Supporting Documents (optional):PhoneThis field is for validation purposes and should be left unchanged.
