Application for Employment s25

NOTICE TO ALL APPLICANTS:

Screening tests for ALCOHOL & ILLEGAL DRUG USE may be required before hiring and during your employment at RWA, Inc.

Thank you for applying with RWA, Inc. Please read the following so that we may give your application full consideration.

1. Be sure ALL sections of the application are filled out completely and thoroughly and ALL questions are answered. Your application cannot be considered if it is not complete.

2. Be sure to account for ALL time periods in the last ten (10) years, show the dates (from and to) of unemployment.

NOTE: While we are happy to have a copy of your resume, a resume cannot be substituted for our application.

3. Be sure to show the company name of your former employers, as well as address, phone number, supervisor’s name and reason for leaving position. If you operated your own company, we must have your business license number.

4. After completing the application and checking it for completeness and accuracy, please sign and date where required.

5. Please submit your completed application to the Human Resources Department.

NOTE: WE ARE UNABLE TO INTERVIEW YOU WITHOUT A FULLY COMPLETED APPLICATION.

RWA INC EMPLOYMENT APPLICATION 1 APPLICATION FOR EMPLOYMENT RWA, Inc. ______RWA, Inc. is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, pregnancy, national origin, ancestry, age, marital status, sexual preference, veteran status, disability or medical conditions. You may leave blank any questions, which you believe could be used for that purpose.

______SECTION 1: PERSONAL

DATE: ______

Last Name First Middle Initial Social Security Number

______

Street Address City State Zip Code Telephone

______

Valid Driver’s License? Yes No Other name(s) you have used while employed: Yes No ______

If hired, can you provide proof of legal right to work in the U.S.? Yes No

Have you ever applied with RWA, Inc. before?  Yes  No If yes, when and where? ______

Have you ever been employed by RWA, Inc.?  Yes  No If yes, give dates and location ______

Are you or have you ever been employed by the U.S. Government (including Presidential appointment), whether as an active duty military member or a civilian employee?  Yes  No If yes, hiring manager may require additional information.

Have you ever been convicted of a felony or other crime that is fraudulent in nature or involved a breach of trust?  Yes  No If yes, please explain.(Note: A conviction is not an automatic bar to employment. All circumstances will be considered).

______SECTION 2: JOB INTEREST

DESIRED SALARY: ______DATE AVAILABLE ______

How did you become interested in RWA, Inc.? Position desired:

______

Are you willing and able to work: Will you accept out of town assignments? Overtime?  Yes  No Traveling  Yes  No  Yes  No

______SECTION 3: EDUCATION

Did you graduate from high school?  Yes  No If no, have you passed a G.E.D test or equivalency?  Yes  No

Additional space, if needed, is provided on the back of this application. SCHOOL CITY AND STATE MAJOR AREA OF STUDY DATES ATTENDED DID YOU GRADUATE DEGREE RECEIVED College From: to: Yes No

Trade From: to: Yes No

Other From: to: Yes No

2 Scholastic Honors and Awards

Thesis/Dissertation Topic

______SECTION 4: RELATED JOB INFORMATION Latest Publications, Inventions or Scientific Awards received: ______Professional Registration?  Yes  No If yes, list licenses or certificates that you have. LICENSE OR CERTIFICATION STATE OR OTHER LICENSING AGENCY DATE OF LATEST LICENSE OR CERTIFICATION ______

______

______SECTION 5: LANGUAGES: Indicate foreign language(s) ______List language(s) in the box applicable to your language ability.

LANGUAGE ABILITY FLUENT/PROFICIENT CONVERSATIONAL SLIGHT SPEAK READ WRITE

______SECTION 6: SKILLS Please indicate your skills below. Indicate proficiency level (high, moderate, low).

SWITCH BOARD 10 Key Touch 10 key Sight CALCULATOR DATA ENTRY wpm TYPING wpm SHORTHAND DICTATION WORD PROCESSING DRAFTING AUTOCAD OTHER List any office equipment, computer hardware and software packages or CAD equipment which you have experience operating.

______SECTION 7: U.S. MILITARY SERVICE Branch of Service Dates of Active Service Rank at discharge

______From: To: ______

Service Schools or Special Experience ______

SECURITY: Have you ever held a security clearance by the U.S. Yes No

If yes, please indicate the type of clearance granted: ______

Secret Top Secret L Q

When was this clearance last active: ______

RWA INC EMPLOYMENT APPLICATION 3 ______SECTION 8: REFERENCES: List below the names of three references we may contact who can comment on your work qualifications. Please do not include relatives.

NAME ADDRESS TELEPHONE OCCUPATION NUMBER

______SECTION 9: EMPLOYMENT RECORD

Please list all previous employment for past ten years and begin by listing your last or present employment first. Periods of unemployment for a month or more should be indicated. Additional space, if needed on the back of this application.

A RESUME MAY NOT BE SUBMITTED FOR COMPLETION OF THIS SECTION

If you are presently working, may we contact your employer? Yes No

(1) EMPLOYER NAME STREET ADDRESS CITY STATE TELEPHONE#

______From: Starting Starting Starting Hours Mo. Yr. Salary Job Title Worked Per Week

______

To: Final Final Final Hours Mo. Yr. Salary Job Title Worked Per Week

______Principal Business Name and Title of Immediate Supervisor Telephone#

______

Describe your Duties

______

Reason for leaving

______

SUPPLEMENTAL SECTION: List any additional information you would like RWA, Inc. to consider. ______

______

4 (2) EMPLOYER NAME STREET ADDRESS CITY STATE TELEPHONE#

______To: Final Final Final Hours Mo. Yr. Salary Job Title Worked Per Week

______

Principal Business Name and Title of Immediate Supervisor Telephone #

______Describe your Duties

______

Reason for Leaving

______

______Describe your Duties ______

______

Reason for Leaving

______

RWA INC EMPLOYMENT APPLICATION 5 (4) EMPLOYER NAME STREET ADDRESS CITY STATE TELEPHONE#

______

Reason for Leaving

______

Reason for Leaving

______

______6 (6) EMPLOYER NAME STREET ADDRESS CITY STATE TELEPHONE#

______

Reason for Leaving

______

I understand that, if hired, my employment may be terminated by me or by the firm at any time, with or without notice, and with or without cause. I understand this policy cannot be changed other than by an express written agreement signed by me and RWA, Inc. Chief Executive Officer.

I certify that, to the best of my knowledge and belief, the answers give by me to the foregoing questions and the statements made by me in this application are correct and complete. Any offer of employment will be predicated upon the truthfulness of the statements I have made in this application and all supplements submitted. I understand that if RWA, Inc. should find that any statements I have made in this application are untruthful, any job offer extended to me will be withdrawn, and if I have been employed by the firm, I will be subject to dismissal.

I understand, that if hired, I may have access to confidential information regarding various aspects of RWA, Inc. business. RWA, Inc. follows the practice of requiring new employees at the time of employment to sign an agreement for assignment of inventions and a covenant against disclosure. I understand that I may be required to sign such an agreement as a condition of employment.

I authorize investigation of all statements contained in this application for employment, and I authorize you to communicate with all my former employers, school officials and persons named as references. I authorize RWA, Inc. to conduct criminal background investigation at their discretion and I agree that RWA, Inc. and persons contacted by RWA, Inc. in investigating the information contained in this application shall not be held liable in any respect if an employment offer is not made, is withdrawn or my employment is terminated as a result of information received during the investigation.

Any conflict of interest regarding employment with RWA, Inc., or omission of material information on this application, will be grounds for immediate termination.

______

Signature Date

RWA INC EMPLOYMENT APPLICATION 7 VOLUNTARY SELF-IDENTIFICATION FORM

SPECIAL DISABLED VETERAN: Are you a Special Disabled Veteran? A Special Disabled Veteran means (1) a veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Veterans Administration for a disability (a) rated at 30 percent or more or (b) rated at 10 to 20 percent in the case of a veteran who has been determined under Section 1506 of Title 38, U.S.C. to have a serious employment disability or (2) a person who was discharged or released from active duty because of a service-connected disability.

NO YES

DISABLED INDIVIDUAL: The Americans with Disabilities Act (ADA) defines an “individual with a disabilty” as a person who: (1) has a physical or mental impairment that substantially limits one or more major life activities; (2) has a record fo such an impairment; or (3) is regarding as having such an impairment.

Do you have any limitations due to your disability that may affect your ability to satisfactorily perform the position for which your are applying?

NO YES

If YES, explain: ______

______

Are there any reasonable accommodations that we could make that would enable you to perform the job properly and safely?

NO YES

If YES, please explain: ______

______

Signature of Applicant ______Date ______

RWA, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

For Office Use Only: Hire Not Hired Date of Hire:______Reasons for rejection (Circle One) Position: ______A. Does not meet minimum standards Rate of Pay: ______B. Others better qualified C. No suitable opening D. Experience not relevant E. Other (Specify)

8 VOLUNTARY SELF-IDENTIFICATION FORM

Last Name First Name Middle Initial Social Security Number:

Position Applied For:

The following information is being gathered not for employment decisions but for record keeping in compliance with Federal Regulations. This information will be kept separate from your Employment Application. Your responses are strictly voluntary and will help in developing and monitoring our Affirmative Action Programs.

Information provided will be kept confidential except that (1) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans and disabled individuals, and regarding necessary accommodations, (2) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment, and (3) government officials investigating compliance will be informed.

If you choose not to answer any of these questions, you will not be subject to adverse treatment. However, if you choose not to “self- identify”, we are required under Federal regulations to maintain race, sex, and disability information on the basis of visual observation or personal knowledge. If you do not wish to furnish this information, please initial below:

I do not wish to furnish the following information: ______Initials Date

SEX: Male Female RECRUITMENT SOURCE: State Employment Office (EDD) Advertisement (Please specify) ______RACE: Community Agency (Please specify) ______Black Employee Referral (Please specify) ______Hispanic School/College (Name of School/College) ______Asian/Pacific Islander Walk-in American Indian/Alaskan Native Rehire White Other (Please specify) ______

VIETNAM ERA VETERAN Are you a veteran of the Vietnam era? A veteran of the Vietnam era means a veteran, any part of whose active U.S. military, naval, or air service was during the period August 5, 1964 through May 7, 1975 and who (1) served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty because of a service-connected disability.

NO YES

RWA INC EMPLOYMENT APPLICATION 9

RWA, Inc.

PRE-EMPLOYMENT DRUG TESTING POLICY

All job applicants at RWA, Inc. will undergo screening for the presence of illegal drugs as a condition for employment.

Applicants will be required to voluntarily submit to a urinalysis test at a laboratory chosen by RWA, Inc., and by signing a consent agreement, will release RWA, Inc. from liability. (Any applicant with positive test results will be denied employment at that time.) The company will not discriminate against applicants for employment because of past abuse of drugs or alcohol. It is the current abuse of drugs or alcohol, which prevents employees from properly performing their jobs that the company will not tolerate.

PRE-EMPLOYMENT AGREEMENT

PLEASE READ CAREFULLY

I freely and voluntarily agree to submit to a urinalysis (drug screen) as part of my application for employment at RWA, Inc. I understand that either refusal to submit to the urinalysis screen or failure to qualify according to the minimum standards established by RWA, Inc. for this screen might disqualify me from further consideration for employment.

I further understand that upon commencement of employment with RWA, Inc., I may again be required to submit to a urinalysis screen. I understand that refusal to take a requested urinalysis screen or failure to meet the minimum standards set for the screen may result in immediate suspension or discharge. In the event that employment commences prior to the employer receiving the drug test results, I understand that I will be immediately discharged if the result comes back positive.

I have read in full and understand the above statements and conditions of employment.

______Applicant's Signature Date

Driver License Information: State: ______DL #______

*Please note: The best legal advice instructs us to have this agreement form attached to the employment application.