PERSONAL

Last Name:   First Name:   Middle:
Date:   Soc. Sec. #:
Street Address:   Home Phone: ()
City, State, Zip:   Work Phone: ()
Position applied for:
Referred by: Advertisement Private Employment Agency Friend Relative No One Govt. Employment Agency Other ---   If other, please specify name:

Are you over 18 years of age? Yes     No     If NO, a work permit is required.

To the best of your knowledge, are you legally eligible to work permanently in the United States? Yes   No
(Should you be hired, you will be required by law to provide documents verifying your employment eligibility.)

Date you are available to start work:    Salary or Wages desired: $

Have you ever applied for work with us before? Yes   No     If YES, enter date here:
Were you ever employed by us before? Yes   No    If YES, enter date here:

Are you applying for full time employment? Yes   No  Can you work overtime if necessary? Yes   No
If hired by R.L. Reppert, Inc. you will be required to work 8 (eight) hours per day (normally 7am to 3:30 pm), 5 (five) days per week.  Can you meet this requirement? Yes   No
If NO, please explain:

Are you employed at the present time? Yes   No

Do you have any relatives now employed by this company? Yes   No     If YES, please list name(s):

Do you have a disability which would limit or prohibit you from performing this work for which you have applied? 
Yes   No    If YES, please explain:

Have you been convicted of a felony within the last 7 years? Yes   No     If YES, please describe (a conviction does not necessarily disqualify an applicant for the position being applied for).

Do you have reliable transportation in order to get to a job within a 100 mile radius of the Lehigh Valley? Yes   No
Do you have a valid driver's license? Yes   No

SPECIAL QUALIFICATIONS OR SKILLS
Use this space to describe any special qualifications or skills you have acquired through special training, prior employment or general experience.

EXPERIENCE
Please check the items below that you consider yourself FULLY EXPERIENCED with.

Apartment & Project Homes                     Custom Homes
Housing for the Elderly                               Nursing Homes
Retail Stores                                              Offices
Shopping Centers                                      Supermarkets

Drywall on wood framing                           Curved partitions
Drywall on metal framing                            Suspended furring
Vinyl covered drywall                                 Demountable partitions
Solid gypsum shaft walls                             Mig welding
Drywall finishing                                         Stick welding
Sound control drywall                                 Rigid insulations
Plastering                                                    Fiberglass insulations
Wood framing                                             Acoustical ceilings
Steel stud framing                                        Stucco
Curtain wall construction                             E.I.F.S.
Steel doors & frames

EDUCATION

High School or Vocational School
Name:
Location:
Number of years completed?    Did you graduate? Yes   No
What was your course of study? 

College
Name:
Location:
Number of years completed?     Did you graduate? Yes   No
What was your major?   Degree:
Did you enroll in a post graduate course of education? Yes   No
If YES, what was your post graduate field of study?
Degree:

Trade, Business or Correspondence School
Name:
Location:
Number of years completed?     Did you graduate? Yes   No
What was your course of training or study?

FOREIGN LANGUAGES

Indicate foreign language(s) you are familiar with:
Language:    Fluent  Good  Fair  Speak  Read  Write
Language:    Fluent  Good  Fair  Speak  Read  Write

MEMBERSHIPS

List Businesses, Trade, Professional, Community or Activities Memberships and any offices you may have held. (exclude any organizations the name and character of which would reveal race, religion, national origin or any other protected status):

PRIOR EMPLOYMENT
(Start with most recent employer)

Employer:   Phone:
From: To:   Position:
Address:
Duties:

Supervisors Name: Starting Salary: Final Salary:
Reason for Leaving:

Employer:   Phone:
From: To:   Position:
Address:
Duties:

Supervisors Name: Starting Salary: Final Salary:
Reason for Leaving:

Employer:   Phone:
From: To:   Position:
Address:
Duties:

Supervisors Name: Starting Salary: Final Salary:
Reason for Leaving:

Employer:   Phone:
From: To:   Position:
Address:
Duties:

Supervisors Name: Starting Salary: Final Salary:
Reason for Leaving:

MILITARY SERVICE

Were you a member of the U.S. Armed Forces? Yes   No     Branch:
Describe briefly your military duties:
  Years served:    Rank at discharge:

PERSONAL REFERENCES
List three references (exclude relatives or former employers)

Name:   Address:   Phone:
Name:   Address:   Phone:
Name:   Address:   Phone:

APPLICANT'S STATEMENT

The information provided by me in the application for employment is true and complete to the best of my knowledge.  Should I be employed by R. L. Reppert, Inc., any misrepresentation or any false statement contained herein may be considered cause for possible dismissal.

R. L. Reppert, Inc. has my permission to contact directly or employ the services of investigative agencies to obtain all necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history or credit standing and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me.  I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to R. L. Reppert, Inc.

I understand this application does not constitute an employment contract of any kind.  Should I be employed by R. L. Reppert, Inc., I may resign such employment at any time at my discretion with or without prior notice and R. L. Reppert, Inc. may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

This application will be considered valid for a period of 7 (seven) days.  After 7 (seven) days it may be necessary for me to submit a new application.

I have read and understand the above statement and I agree with the terms stated: Yes