Applicant Information

^* Applicant Name

^* Address
(Include City, State and Zip Code):

^* Telephone Number

^* Email Address

Employment Position

^* Position(s) applying for

^* How did you hear about this position?

^* If needed, are you available to work overtime?

^* On what date can you start working if you are hired?

^* Do you have reliable transportation to and from work?
YesNo

Personal Information

Do you have any friends, relatives, or acquaintances working for Wayne County Rock Inc?
If so, state name & relationship:

^* Are you 18 years of age or older?
YesNo

^* Are you a U.S. Citizen or approved to work in the United States?
YesNo

What documents can you provide as proof of citizenship or legal status?

^* Will you consent to a mandatory controlled substance test?
YesNo

Have you ever been convicted of a criminal offense (felony or misdemeanor)?
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: Wayne County Rock Inc complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Education and Training

Please include name, location (city, state), year graduated, and degree earned.

High School:

College/University:

Vocational/Specialized Training:

Military
Are you a member of the Armed Services?

• What branch of the military did you enlist?

• What was your military rank when discharged?

• How many years did you serve in the military?

• What military skills do you possess that would be an asset for this position?

Previous Employment

Please include the following:

• Employer Name

• Job Title

• Supervisor Name

• Employer Address

• City, State and Zip Code

• Employer Telephone

• Dates Employed

• Reason for Leaving

Previous Employment (1)

Previous Employment (2)

Previous Employment (3)

References

Please provide 2 personal and professional reference(s):

At-Will Employment

The relationship between you and the Wayne County Rock Inc is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Wayne County Rock Inc. No representative of Wayne County Rock Inc has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

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