1.800.348.4RPM

RPM Companies - On-line Employment Application

AN EQUAL OPPORTUNITY EMPLOYER

DATE OF APPLICATION

PERSONAL INFORMATION

NAME


First Name	M.I.	Last Name

PRESENT ADDRESS


Address

City	State/Province	ZIP/Postal Code

PERMANENT ADDRESS


Address

City	State/Province	ZIP/Postal Code

PHONE NO.

REFERRED BY

EMPLOYMENT DESIRED

POSITION APPLYING FOR

WHICH RPM COMPANY ARE YOU APPLYING FOR?

RPM & Associates, Inc.

RPM Solutions, Inc.

RPM Innovations, Inc.

DATE YOU CAN START

SALARY DESIRED

TYPE OF EMPLOYMENT DESIRED

Full Time

Part Time

Temporary

Seasonal

Educational Co-op

HAVE YOU EVER BEEN EMPLOYED HERE BEFORE?

Yes No
IF YES, WHEN

HAVE YOU EVER FILED AN APPLICATION HERE BEFORE?

Yes No
IF YES, WHEN

ARE YOU A U.S. CITIZEN?

Yes No

ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.?

Yes No

ARE YOU OVER 18 YEARS OF AGE?

Yes No

HOW DID YOU LEARN ABOUT US?

Advertisement
Friend
Relative
Employment Agency
Other

ARE YOU ON LAY-OFF AND SUBJECT TO RECALL?

Yes No

WILL YOU TRAVEL IF JOB REQUIRES IT?

Yes No

WILL YOU WORK OVERTIME IF REQUIRED?

Yes No

WILL YOU WORK SHIFTS?

Yes No

ARE YOU ABLE TO OBTAIN A PASSPORT/VISA FOR TRAVEL IF REQUIRED?

Yes No

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Employment History

List your last four (4) employers starting with the most recent, including military experience. Explain any gaps in employment in comments section below.

Employer #1
(Most Recent)

Employer

Telephone

Address

Address Line 1 Address Line 2

City	State	ZIP

Job Title

Dates Employed
FROM TO

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

Later

Hourly Rate/Salary Starting $ per

Hourly Rate/Salary Ending $ per

Summary of Work

Employer #2

Employer

Telephone

Address

Address Line 1 Address Line 2

City	State	ZIP

Job Title

Dates Employed
FROM TO

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

Later

Hourly Rate/Salary Starting $ per

Hourly Rate/Salary Ending $ per

Summary of Work

Employer #3

Employer

Telephone

Address

Address Line 1 Address Line 2

City	State	ZIP

Job Title

Dates Employed
FROM TO

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

Later

Hourly Rate/Salary Starting $ per

Hourly Rate/Salary Ending $ per

Summary of Work

Employer #4

Employer

Telephone

Address

Address Line 1 Address Line 2

City	State	ZIP

Job Title

Dates Employed
FROM TO

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

Yes

Later

Hourly Rate/Salary Starting $ per

Hourly Rate/Salary Ending $ per

Summary of Work

Comments (including explanation of gaps in employment)

Skills and Qualifications Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company.

Educational Background

A. List last three (3) schools attended, starting with last one. B. List number of years completed. C. Indicate degree or diploma earned, if any. D. Grade Point Average or Class Rank and, E. major and minor field of study (if applicable).

A. School	B. No. of Years Completed	C. Degree Diploma	D. GPA Class Rank	E. Major	E. Minor

List any foreign language(s) and check box that best describes your skill level.

Language	Read and Write	Read and Speak	Read only	Speak only

References

List name and telephone number of three business/work references that are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.

Name	Telephone	Years Known

In case of Emergency Notify

Name	Address	Phone No.

List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, color, disability, or other protected status.)

List any additional information you would like us to consider.

Resume

In order to be considered for employment, you must provide a resume.

Please attach a resume if you have an electronic version. Select the "Browse" button below to select your file.

In order to attach a resume, it must be in one of the following formats.

Adobe Acrobat PDF (.pdf)
Microsoft Word (.doc, .docx)

The file must also be less than 25 Mb.

If you would like to send your a resume directly, e-mail it to Personnel@RPMandAssociates.com. Be sure to include your name and the position you are applying for.

Agreement

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

It is understood and agreed upon that any offer of employment will be contingent on the following:

   1. Passing a pre-employment drug screen.
   2. Acceptable background check.
   3. Acceptable motor vehicle report.
   4. Completion of a post-offer medical questionnaire.
   5. When applicable, completion of a post-offer functional job assessment.
   6. When applicable, completion of a Department of Transportation Physical.
   7. Proof of U.S. Citizenship or immigration status will be required.
   8. Agreement to comply with our clean shaven policy in order to meet
       OSHA standards for respirator fit testing as well as respirator
       use when required.
   9. Agreement to comply with all of our RPM company policies.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application.

About RPM & Associates

RPM engineers and manufactures specialty parts for many industrial needs such as these upgraded soot blower front support rollers.

Rapid City, the Black Hills, and South Dakota ... Our Home

The Black Hills Wild Horse Sanctuary is home to over 1,000 free-roaming horses of all breeds and mixes. It's a taste of the West the way it was 300 years ago.