Employment Application

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, veteran status, or genetic information. Consistent with the Americans Disabilities Act, applicants may request accommodations needed to participate in the application process.

Please do not include any PII in this employment application. (Personally identifiable information (PII) is any data that could potentially identify a specific individual. Any information that can be used to distinguish one person from another and can be used for de-anonymizing anonymous data can be considered PII.)

First Name

Middle Name

Last Name

Current Address

Address 1

Address 2

City

State

Zip Code

Phone

Are you 18 year of age or older?

Referral Source

Who referred you to RMCU?

Desired Position

Position Description / Title

Date Available to Start

Salary Desired

Can you perform all of the functions of the job you are seeking?

If no, describe how you will be able to perform the functions in question with or without reasonable accommodation:

Current & Past Employment

Are you currently employed?

Have you ever applied to RMCU before?

Have you ever worked for RMCU before?

Do you know anyone who currently works for RMCU?

Have you ever been convicted of a criminal offense involving dishonesty or breach of trust? (You may not be automatically disqualified if you have a criminal record.)

Have you ever had bond coverage modified, revoked, and/or applied for and denied?

Date you began employment

Date finished employment

High School

High School Name

High School Location

High School Last Year Completed?

Did you graduate high school?

High School Subjects Studied & Degree(s) Received

College

College Name

College Location

College Last Year Completed

Did you graduate college?

Other subjects studied & Degree(s) Received

Trade, Business or Correspondence School

Other School Name

Other School Location

Did you graduate other school?

Other school subjects studied & degree(s) received

Additional Skills & Knowledge

Subject of special study or research work

Job related skills (people, skills, problem solving skills, communication skills, etc)

Former Employer #1

Start Date #1

End Date #1

Name of Employer

Position

Salary (upon leaving)

Supervisor's Name

Reason for leaving

Address of Employer #1

Address 2 of Employer #1

City of Employer #1

State of Employer #1

Zip Code of Employer #1

Former Employer #2

Start Date #2

End Date #2

Name of Employer #2

Position #2

Salary (upon leaving) #2

Supervisor's Name #2

Reason for leaving #2

Address 1 of Employer #2

Address 2 of Employer #2

City of Employer #2

State of Employer #2

Zip Code of Employer #2

Former Employer #3

Start Date #3

End Date #3

Name of Employer #3

Position #3

Salary (upon leaving) #3

Supervisor's Name #3

Reason for leaving #3

Address 1 of Employer #3

Address 2 of Employer #3

City of Employer #3

State of Employer #3

Zip Code of Employer #3

References

Reference's First Name

Reference's Last Name

Relationship / Position

Years Acquainted

Reference's Phone Number

Reference's Address

Reference's City

Reference's State

Reference's Zip Code

Employment Application