Careers

Application for Employment

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

For Rhode Island Employers Only: This Company is subject to the Workers' Compensation laws of the State of Rhode Island.*

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Applicant Name*

Position Applied For*

Telephone Number*

Alternate Telephone Number

Present Address (Street, Apartment or Unit Number)*

City*

State*

Zip*	How long have you lived there? (Years/Months)*

Email Address (Optional)

Desired Salary/Hourly Rate*

If under the age of 18, can you produce the necessary work certificate at the time of employment?

Type of employment desired?*

(Specify Hours)*

Are you willing to work overtime?*

Date on which you can start work if hired*

Have you previously applied for employment with this Company?*

If Yes, when and where did you apply?

Have you ever been employed by this Company?*

If Yes, provide dates of employment, location, and reason for separation from employment.

If applicable, below list any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc

Education	School Name and Location (Address, City, State)	Course of Study/Major	Graduate?	Years Completed	Honors Received
High School
College
Graduate
Trade School

WORK EXPERIENCE
Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self- employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer "see résumé."

Employer Name

Address

Type of Business

Telephone

Dates Employed From

Job Title

Duties

Supervisor's Name

May we contact?

If No, why not?

Wages Start

Wages Final

Reason for Leaving?

What will this employer say was the reason your employment was terminated? Were you ever disciplined? If so, for what? How much notice did you give when resigning? If none,explain.

Employer Name

Address

Type of Business

Telephone

Dates Employed From

Job Title

Duties

Supervisor's Name

May we contact?

If No, why not?

Wages Start

Wages Final

Reason for Leaving?

What will this employer say was the reason your employment was terminated? Were you ever disciplined? If so, for what? How much notice did you give when resigning? If none,explain.

Have you ever been terminated or asked to resign from any job?*

If Yes, how many times

Has your employment ever been terminated by mutual agreement?*

If Yes, how many times

Have you ever been given the choice to resign rather than be terminated?*

If Yes, how many times

If you answered Yes to any of the above three questions, please explain the circumstances of each occasion.

REFERENCES [Optional]
Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.

Name	Position	Company	Work Relationship	Telephone

Please list the names of personal references (not previous employers or relatives) who you know that we may contact

Name	Occupation	Address	Telephone	Number of Years Known

DRIVING INFORMATION [Optional] (Complete only if driving is an essential function of the job for which you are applying).

Do you have a valid driver’s license?

If yes, License No.

State

Expiration Date

If you do not have a driver’s license for the state in which you currently reside, why not?

Has your license ever been suspended or revoked?

If Yes, explain

Do you have personal automobile insurance?

If Yes, explain

Have you ever been denied personal automobile insurance or has it ever been terminated or suspended? If Yes, explain

Please list all moving traffic violations in the last five (5) years:

Offense	Date	Location	Comment

Have you ever been convicted of, plead guilty or nolo contendere to a crime or have you ever been involved in a case that resulted in an adjudication withheld or nolle prosequi?* Are you currently awaiting trial, sentencing or other disposition of a criminal charge?* If the answer to either question is yes, please explain (state the date, type of crime, place of occurrence, disposition):

Note: Conviction of a crime will not necessarily disqualify you from employment. Each conviction will be judged on its own merit with respect to time and job relatedness.

Have you ever been discharged or requested to resign from a position?* If so, explain:

Please attach your resume here:

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