Applicants

Applicants

First Name*

Middle Name

Last Name*

Social Security Number*

Email Address

Home Address Street*

Home Address City*

Home Address State*

Home Address Zip Code*

Phone Number*

Alternate Phone Number

Mailing Address different from "Home Address"?*

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Mailing Address Street

Mailing Address City

Mailing Address State

Mailing Address Zip Code

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Are you age 18 or older?*

(If no, hire is subject to verification that you are of legal minimum age to work)

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Position(s) applying for*

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Salary/Wage desired*

Have you ever been employed with us before?

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If yes, give dates

On what date would you be available for work?

Emergency Contact Name?*

Emergency Contact Number?*

Emergency Contact Address

Education

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Name and Location of School

Number of years attended?

Did you Graduate? Degree obtained?

Subjects Studied

Add Education 2

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Education 2

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Name and Location of School 2

Number of years attended 2

Did you Graduate? Degree obtained? 2

Subjects Studied? 2

Add Education 3

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Education 3

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Name and Location of School? 3

Number of years attended? 3

Did you Graduate? Degree obtained? 3

Subjects Studied? 3

Add Education 4

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Education 4

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Name and Location of School? 4

Number of years attended? 4

Did you Graduate? Degree obtained? 4

Subjects Studied? 4

Describe any experiences, skills, certifications, or qualifications that would be of special benefit in the job for which you are applying.

Are you currently employed?

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We routinely contact an applicant’s current employer for reference checks. Would this pose any particular difficulty for you?*

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Do not contact current employer, please explain.

Current or Last Employer Name

Current or Last Employer Phone

Current or Last Employer Address

Current or Last Employer Date Range Start

Current or Last Employer Date Range End

If current, enter today's date.

Current or Last Employer Supervisor

Current or Last Employer Weekly Wages

Current or Last Employer Position and Duties

Current or Last Employer Reason for Leaving

Previous Employer (1) Name

Previous Employer (1) Phone

Previous Employer (1) Address

Previous Employer (1) Date Range Start

Previous Employer (1) Date Range End

Previous Employer (1) Supervisor

Previous Employer (1) Weekly Wages

Previous Employer (1) Position and Duties

Previous Employer (1) Reason for Leaving

Previous Employer (2) Name

Previous Employer (2) Phone

Previous Employer (2) Address

Previous Employer (2) Date Range Start

Previous Employer (2) Date Range End

Previous Employer (2) Supervisor

Previous Employer (2) Weekly Wages

Previous Employer (2) Position and Duties

Previous Employer (2) Reason for Leaving

Please explain all periods of unemployment

Have you ever been terminated from employment?

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Terminated? Please explain

Vehicles

The following section must be completed if you are applying for a position which requires the operation of a motor vehicle, owned or leased by the company, or if you must use your own vehicle for company purposes.

Will you be required to operate a company vehicle?

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Driver’s License No.

State Issued

Expiration Date

Do you have auto liability insurance?

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Name of insurance company and expiration date

Has your driver’s license ever been suspended or revoked for any reason?

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If yes, please give date and reason

Have you been involved in a vehicle accident of any type within the past five years?

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If yes, give date(s) and the nature and severity of the accident(s)

List traffic citations you have received during the five years proceeding date of this application, and state the disposition of each, such as “dismissed”, “paid fine”, “defensive driving”, etc. Include Date Type and Disposition

If you have ever been convicted of driving while intoxicated or under the influence, please explain:

Safety

Note: If you are hired for a position, which requires driving, you must keep us informed of any changes in your driving record. Employers in Texas have a legal duty in regard to each employee’s safety. Your, your fellow workers’ and our customers; safety is of utmost importance to Rykin Pump Company, Rykin Electric, and Rykin Sprinkler Systems. It is neither beneficial for neither you nor us to place you in a job where you have a higher risk of injury because of a physical or mental condition. As an Equal Opportunity Employer, we consider applicant’s for all employment regardless of their disabilities; however in addition to our own requirement, the Americans with Disabilities Act also requires us to make certain that each employee is capable of performing the essential functions of the job. Therefore, you must be honest with us in regard to your personal evaluation as to your abilities to perform the essential functions as described in the job description. If you are unable to perform the essential functions of the job, we welcome you to discuss any needs for accommodations that would allow you to perform the job in accordance with the job description.

Do you have the physical and/or mental capabilities to perform the essential functions of the job?

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if no, state the accommodations that would allow you to perform the job.

Certification of Application

I certify that all information given on this application is true, correct and complete to the best of my knowledge. I also certify that I have accounted for my last three work experiences and any relevant training on this application, and that I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. Rykin Pump Company, Rykin Electric, and Rykin Sprinkler Systems is hereby authorized to make any investigation of my past employment and current employment if indicated above that this would not pose any difficulty, educational, credit, or criminal history through any investigative agencies or bureaus of its choice. I release all relevant parties from all liability of any damages resulting from furnishing such information. If employed by Rykin Pump Company, Rykin Electric, and Rykin Sprinkler Systems, I agree to abide by its rules and regulations. I understand that discovery of misrepresentation or omission of facts herein will make me ineligible for employment or will be cause for immediate dismissal. I agree to furnish additional information as may be required to complete my employment file. I understand that operating conditions may require me to temporarily work shifts other than the one I am applying and I agree to such scheduling change as directed by my supervisor. I have received, read, and reviewed the job description of the position for which I am applying and understand that I must be capable of performing the essential functions contained therein. I also understand that my employment is subject to the completion of the Medical Examination and Mobility Evaluation and that my continued employment may be conditioned upon maintaining a favorable health evaluation. I also agree that all information concerning said physical examination can be supplied to Rykin Pump Company, Rykin Electric, and Rykin Sprinkler Systems or an authorized agent of the company upon their request. I understand that this is an application for employment and that no employment and that no employment contract, either express or implied, is being offered. I also understand that if employed, such employment is for an indefinite period and can be terminated at will by either party, with or without notice, at any time, for any or no reason, and is subject to change in wages, conditions, benefits, and operating policies.

Initials are agreement with Certification of Application*

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Date*

Employment Applicant’s Release of Employment Records

I hereby authorize Rykin Pump Company, Rykin Electric, and Rykin Sprinkler Systems to investigate all facts contained in my application for employment with said company, and authorizes the release of any and all information by my present and past employers, wherever located, which may be required for a reference check. I further authorize all of my previous employers and current employers to five any and all information concerning my employment and any other pertinent information which said employers may have, personal or otherwise and I release all parties from all liabilities for any damages which may result from the furnishing of said information. A copy of this release shall be as valid as the original.*

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