Employment Application Form – Roaring Spring Water Employment Application PDF Download APPLICATION FOR EMPLOYMENT ROARING SPRING WATER A DIVISION OF ROARING SPRING BLANK BOOK COMPANY The Roaring Spring Blank Book Company is an Equal Opportunity employer. In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, sexual orientation, disability, or any other protected group status.Personal InformationDate* Name* First Middle Last Present Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Work PhoneCell PhoneEmail Address* Social Security Number*Are you 18 years or older?*YesNoAre you eligible to work in the United States?*YesNo(Proof of eligibility will be required upon offer of employment)Have you ever been convicted, pled guilty, “no contest”, or admitted guilt to any misdemeanor or felony crime?*YesNoIf yes, explain circumstances and date (a record of conviction will not necessarily disqualify you from employment.)Have you previously worked for any division of Roaring Spring Blank Book listed below?*YesNoIf yes, please state which division and dates of employment:How did you learn of this opening?*Have you ever been a member of the armed forces of the United States?*YesNoIf yes, list any skills developed in the military which relate directly to the job being applied for:Have you used tobacco within the last 6 months?YesNoApplicants for Pennsylvania based jobs should answer this question. (Applicants for West Virginia based jobs should not answer the question.)Position being applied for:*Type of position you are seeking:*Full-timePart-timeTemporarySummer/StudentAre you currently employed?*YesNoMay we contact your present employer?YesNoDate you can start:* Wage desired:*EDUCATIONHigh SchoolName and LocationCourse of Study and # Years CompletedDegree/DiplomaCollege or UniversityName and LocationCourse of Study and # Years CompletedDegree/DiplomaSpecialized Training, Trade School, etc.Name and LocationCourse of Study and # Years CompletedDegree/DiplomaOther EducationName and LocationCourse of Study and # Years CompletedDegree/DiplomaEMPLOYMENT HISTORYList below all present and past employers over the last seven years, starting with your most recent employer.Employer #1EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Start Date Termination Date Phone NumberStarting Wage RateEnding Wage RateSupervisor's NameJob PositionMajor DutiesReason for leavingEmployer #2EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Start Date Termination Date Phone NumberStarting Wage RateEnding Wage RateSupervisor's NameJob PositionMajor DutiesReason for leavingEmployer #3EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Start Date Termination Date Phone NumberStarting Wage RateEnding Wage RateSupervisor's NameJob PositionMajor DutiesReason for leavingEmployer #4EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Start Date Termination Date Phone NumberStarting Wage RateEnding Wage RateSupervisor's NameJob PositionMajor DutiesReason for leavingPERSONAL REFERENCES (do not list relatives)Reference #1Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Relationship & years acquainted*Reference #2Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Relationship & years acquainted*Reference #3Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Relationship & years acquainted*APPLICANT CERTIFICATION – Please read carefully and sign belowDisclosure to Applicants Concerning Drug/Alcohol Testing If you are offered a position with any of the divisions of the Roaring Spring Blank Book Company, (the Company), you will be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by the Company.Complete and Accurate Information I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. At-Will Employment I understand and agree that if I am employed, my employment will be “at-will” which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. This provision may not apply if an employee is covered under a collection bargaining agreement. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause or with or without notice.Testing Authorization If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug, or medical test required by the Company as a condition of employment. I understand that any offer of employment is contingent upon my participation and successful completion of any required physical or other examination as identified within this application.Investigation Authorization I authorize investigation into all statement and references contained in this application. This may include credit, driving, criminal background, references and other background checks. By applying for this job, I also authorize post-hire investigation into my credit, driving and criminal background.Company Obligation I understand and agree that the Company’s acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the Company has agreed to hire me. I understand that the Company is under no obligation to hire me as a result of accepting this completed application.Application Agreement* I HAVE READ AND UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS. I UNDERSTAND THAT MY APPLICATION WILL NOT BE ACCEPTED UNLESS IT IS COMPLETED IN ITS ENTIRETY, INCLUDING THE VOLUNTARY SELF IDENTIFICATION SURVEY AND MY SIGNATURE APPEARS BELOW. Name* First Last VOLUNTARY SELF-IDENTIFICATION SURVEY FOR ROARING SPRING BLANK BOOK COMPANYIt is the policy of Roaring Spring Blank Book Company to provide equal employment opportunity to all employees and applicants for employment without regard to race, color, sex, national origin, religion, sexual orientation, age, disability or veteran status. Likewise, the Company maintains written Affirmative Action Plans for women, minorities, disabled persons and protected veterans. This Organization is subject to certain non-discrimination and affirmative action record-keeping and recording requirements which require us to invite job applicants and employees to voluntarily self-identify their race/ethnicity and gender. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulation, including those which require the information to be summarized and reported to the federal government for civil rights enforcement purposes.Completion of this sheet is voluntary and is not a requirement for employment. If you choose not to self-identify at this time, please be advised that the Federal Government requires this Employer to determine the information asked below by a visual survey and/or other available information, where possible.Name First Last Date Position Applied For:Division:Roaring Spring Paper ProductsSpring Cove ContainerRoaring Spring Blank Book Company- Corporate OfficeRoaring Spring WaterFrank’s Coffee ServiceGender:MaleFemaileRace: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.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 Philippines, Thailand, and Vietnam.Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.Native Hawaiian or Other Pacific Islander (Not Hispanic of Latino) –A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.Do Not Want to Disclose