Radiant

Employement > Position Descriptions

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Desired Position

Full Time

Part Time

Personal Data

Last Name

First Name

Middle

Social Security

Present Address
City	State	Zip Code	- - Telephone Number
How Long Have You Lived There?

Have You Ever Worked For This Company Before?	Yes	No
If Yes, Please Give Dates and Position.
Do You Have Any Friends Or Relatives Working Here?	Yes	No
If Yes, Name Relationship
How Would You Get to Work?

Have you ever pled guilty, been convicted, entered a plea of no contest, ha prosecution deferred or adjudication withheld for any crime (other than a minor traffic violations)?	Yes No
Are there any criminal charges pending against you?	Yes No
If "Yes" to the above two questions, please give date and details

NOTE: Answering "Yes" to this question does not constitute and automatic bar to employment.

Record Of Previous Employment

Please list the names of your previous employers in chronological order with the present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.

Present or Last Employer	- - Telephone Number
Address
City	State	Zip
Employed From(mo/yr) Employed To (mo/yr)
Pay (Start) $ Pay (Final) $
Your Title or Position
Name & Title of Last Supervisor
Reason For Leaving

Previous Employer	- - Telephone Number
Address
City	State	Zip
Employed From(mo/yr) Employed To (mo/yr)
Pay (Start) $ Pay (Final) $
Your Title or Position
Name & Title of Last Supervisor
Reason For Leaving

Previous Employer	- - Telephone Number
Address
City	State	Zip
Employed From(mo/yr) Employed To (mo/yr)
Pay (Start) $ Pay (Final) $
Your Title or Position
Name & Title of Last Supervisor
Reason For Leaving

Have you ever been terminated or asked to resign from any job?	Yes	No
If yes, Please explain.
Please explain fully any gaps in your employment History
May we contact your current employer?	Yes	No

Previous Experience

Please indicate any actual experience that you have which you
feel is relevant to the position for which you are applying.

Education

Emergency Information
Incase of an accident or other emergency, who should we contact?

Name	Relationship
Address	- - Telephone Number
City	State	Zip
Work Address	- - Work Telephone Number
City	State	Zip

Personal References
Please list persons who know you well, -- not previous employers or relatives.

Name	Occupation	Address (Street, City,State)	Telephone	Yrs known

Driving Information

Do you have a current Driver's License?
State	License No.	Expiration Date
Has your Driver's license ever been suspended or revoked?	Yes No
If Yes, please explain the circumstances
Do you have personal automobile Insurance	Yes No	Insurance Company
Has your Autombile insurance ever been canceled?	Yes No
If Yes, please explain the circumstances
Have you ever been cited for driving under the influence (DUI) or driving while intoxicated (DWI)?	Yes No
If Yes, please explain the circumstances and the outcome.
Please list all Moving traffic violations in the last five (5) years
Offense	Date of Offense	Location
Offense	Date of Offense	Location
Offense	Date of Offense	Location
Offense	Date of Offense	Location

APPLICANT�S STATEMENT

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without notice, and the Company has the same right. No one other than the President of the Company has authority to modify this relationship or may any agreement to the contrary. Any such modification or agreement must be in writing. I understand that the Company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I authorize the Company to investigate my driving record, my criminal record and my credit history, and I understand that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted. This inquiry would include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation. I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information. I certify that all of the information that I provide on this application and in any interview will be true and accurate.I understand that if I am employed and any such information is later found to be false or misleading in any respect, I may be dismissed.

DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THIS STATEMENT

This Application will be considered active for a maximum of thirty (30) days. If you wish to be considered for employment after that time, you must reapply.

by entering your initials you agree to the terms as stated in the Applicant Note and Certification and Release.