Personal Information

Name*

First

Last

Address*

Address 2

City*

State*

Zipcode*

Phone*

Email address*

Position Applied For:*

Source of Referral:*

Salary Desired:

Date Available:*

U.S. Military Service

Branch of the Service

From (month/year)

To (month/year)

Rank & Type of Service

Training & Experience Received

General Information

Are you legally eligible to work in the USA?*

Yes

No

Have you ever applied for employment at AGR?*

Yes

No

If Yes When:

Are you over the age of 18? (if no, you will be required to provide authorization to work.)*

Yes

No

Have you ever applied for employment at AGR?*

Yes

No

If Yes When:

Names and relationship of any relatives currently or previously employed by AGR

Answer the following questions only if you are applying for a position involving the use of Company vehicles or driving your own vehicle on a regular basis

Have you had any motor vehicle accidents or been convicted more than once for any motor vehicle violations in the past 5 years?

Yes

No

Do you hold a driver's license in good standing?

Yes

No

If No Please Explain

Work Availability

Can you work overtime without prior notice?*

Yes

No

Can you work on Sunday if required?*

Yes

No

Employment Experience

Please provide the following information for your current and previous two employers, starting with your most recent employer first. This section must be completed in detail even if you upload a resume.

Employer #1

Current/Previous Employer*

From (month/year)*

To (month/year)*

Address*

City*

State*

Zipcode*

Job Title*

Phone Number*

Can We Contact Them*

Yes

No

Supervisor's Name*

Reason for Leaving*

If Not Reason

Employer #2

Previous Employer

From (month/year)

To (month/year)

Address

City

State

Zipcode

Job Title

Phone Number

Supervisor's Name

Reason for Leaving

Employer #3

Previous Employer

From (month/year)

To (month/year)

Address

City

State

Zipcode

Job Title

Phone Number

Supervisor's Name

Reason for Leaving

Unemployment Record

Account for all periods of unemployment of 30 days or more in the past 5 years.

From

To

What were you doing during this time?

References

Please provide the following information for three professional references from your current or former supervisors or managers.

Please note: Friends, coworkers, and family members cannot be used as professional references.

Reference #1

Name*

Address*

Phone Number*

Occupation*

Years Know*

Reference #2

Name*

Address*

Phone Number*

Occupation*

Years Know*

Reference #3

Name*

Address*

Phone Number*

Occupation*

Years Know*

Special Skills & Qualifications

Summarize special skills, qualifications, licenses, hobbies, professional, business or civic experiences that you think would qualify you for employment. You may exclude those which indicate race, religion, sex, or national origin.

Upload a Resume

Please take a moment to upload a copy of your current resume. While it is not required, attaching your resume is extremely helpful in providing the management team with as thorough an overview as possible of your unique set of skills and experience. To attach your resume to this job application, click on the button below.

Choose File:

By checking this box, I am agreeing that this qualifies as my signature and that this communication is “in writing” as applicable to all laws, state and federal, regarding electronic communication and the content therein.

Consent to Pre-Employment Drug and Alcohol Testing and Release of Results

All offers are contingent upon passing a pre-employment drug and alcohol test. If offered employment,

I,

do hereby consent to undergo a drug and alcohol test as required by the Arthur G. Russell Company Inc. Further, I authorize the hospital, clinic and/or testing facility to release to The Arthur G. Russell Company Inc. the results of such test and I release the hospital, clinic, and/or testing facility, its doctors, and medical personnel from liability from any release or use of this information. Signing this form does not constitute an offer or promise of employment at The Arthur G. Russell Company Inc.

Applicant Signature*

Date*

Consent to Pre-Employment Drug and Alcohol Testing and Release of Results

By checking this box, I am agreeing that this qualifies as my signature and that this communication is “in writing” as applicable to all laws, state and federal, regarding electronic communication and the content therein.

EEO INFORMATION

The following information is requested solely to help us comply with government record keeping, reporting, and other legal requirements. This data is for analysis and reporting purposes only and will be maintained in a confidential file separate from your application for employment and other personnel records. Completion of this data will not affect your opportunity for employment, or terms or conditions of employment, if hired. Your responses to this requested information is strictly voluntary. If you do not wish to complete the survey, please check the box in Section II below, indicating that you prefer not to provide any information contained in this self-identification form.

Name*

Position Applying For:*

How did you hear about us?

Section 1

Gender

Male

Female

Race or Ethnic Group

Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races.

Section 2

I prefer not to provide any information contained in this self-identification form.

DISCLOSURE

I understand that employment will be subject to my submitting documentary proof of my identity and legal eligibility to work.
I have read and understand the privacy policy.
I understand that the employer follows an "employment at will" policy, in that I or the employer may terminate my employment at any time or for any reasons consistent with applicable state or federal law.
I understand that this application is not a contract of employment.
I understand that the company will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named herein, except my current employer if so noted, to provide any information request about me, and I release them from all liability for damage in providing this information.
I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

APPLICATION SIGNATURE

Signing this form does not constitute an offer or promise of employment at The Arthur G. Russell Company Inc.

Applicant's Signature*

Date*

By checking this box, I am agreeing that this qualifies as my signature and that this communication is “in writing” as applicable to all laws, state and federal, regarding electronic communication and the content therein.

Personal Information

Education

High School

College

Post College

Trade School

U.S. Military Service

General Information

Answer the following questions only if you are applying for a position involving the use of Company vehicles or driving your own vehicle on a regular basis

Work Availability

Employment Experience

Employer #1

Employer #2

Employer #3

Unemployment Record

References

Reference #1

Reference #2

Reference #3

Special Skills & Qualifications

Upload a Resume

Consent to Pre-Employment Drug and Alcohol Testing and Release of Results

EEO INFORMATION

Section 1

Section 2

DISCLOSURE

APPLICATION SIGNATURE