Employment Application

General Information                                                                                      

*Last Name

*First Name

Middle Name

Current Address

*Primary Phone Number:	Secondary Phone Number:		*Email Address:
*Street Address	*City/State	/	*Zip

_______________________________________________________________________________________________________

Position(s) desired (list up to 3 below):	Salary Requirement:
Position desired	Date of Availability:
Position desired	Preferred Work Hours:
Position desired	How did you learn about us?
	Employee referral (Name of Employee):

If you have previously been employed by Recruitment Specialists, inc. (RSI), what was your name at that time (if different then stated above)?
Dates of previous employment at Recruitment Specialists, inc. (RSI):

Language Skills

What language (s) do you speak (other than English)?

What language(s) do you read/write (other than English)?

Education

	Institution’s Name	Degree	Year Completed
Highest Level of Education	*	*	*
Additional Education  (College, Trade, Certificate)

Professional Credentials

Professional  Licensure(s)/Registration(s)/Certification(s)

State

License Number

Year Received

Expiration Date

Additional Information      

*Have you ever been convicted of or pleaded guilty to a crime?     Yes        No
If “Yes”, please explain:

*Have you been terminated, disciplined, suspended or discharged by any previous employer? Yes     No
If “Yes,” please explain:

*Are you legally authorized to work in the United States on a regular basis? Yes     No
If “No,” please explain:

Employment History (Include the last 10 years of work history)

*Employer’s Name:		*Employer’s Address:
*Job Title:		*Supervisor’s Name & Title
*Time Employed (Mo. & Yr.)	*From:  *To:	*Supervisor’s Phone Number:
*Reason for Leaving?		*May we contact your employer?	Yes     No
*Position Responsibilities?

Click Links Below to Add Additional Jobs

Add 2nd

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 3rd

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 4th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 5th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 6th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 7th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 8th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

Add 9th

Employer’s Name:		Employer’s Address:
Job Title:		Supervisor’s Name & Title
Time Employed (Mo. & Yr.)	From:  To:	Supervisor’s Phone Number:
Reason for Leaving?		May we contact your employer?	Yes     No
Position Responsibilities?

PROFESSIONAL REFERENCES (those that functioned in a supervisory capacity)

*Name:	*Telephone Number:
*Company:	*Title:
*Address:	*City:
*State:	*Zip
*Relationship:

Add 2nd

Name:	Telephone Number:
Company:	Title:
Address:	City:
State:	Zip
Relationship:

Add 3rd

Name:	Telephone Number:
Company:	Title:
Address:	City:
State:	Zip
Relationship:

___________________________________________________________________________________________________

Read the following carefully before signing. In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, education, educational background, credit record and/or criminal history. My typed name below shall have the same force and effect as my written signature.

*Candidate's/Applicant's Signature:

*I Have Read The Agreed Upon Conditions of Employment Click Here To Read

*required fields

1001 Cromwell Bridge Road, Suite 200 Baltimore, Maryland Phone: 410.825.6186 Toll-Free 800.787.9669