Application for Employment

Please complete all the information and then submit the form. It will be forwarded to the Human Resource Dept. Tel: 409-736-2361 .

Equal access to programs, services and employment is available to all persons.  Those applicants requiring reasonable accommodation to the application and/or interview process should e-mail a representative of the Human Resources Department.

The fields with an * are required to be filled in.

Position(s) applied for:
(RPS™ hires personnel for manufacturing, blending, customer service, & operations management positions.)

Name:  (First, Middle, Last) *

 Address: (Street,State and Zip code)*
*

Telephone #:                  Cell/Beeper/Other Phone#               

*                                               

If you are under 18, and it is required, can you furnish a work permit?  Over 18 YES NO
If "NO", please explain.

Are you legally eligible for employment in this country? YES NO *

Date available to work. 

Pick the employment desired.   Make Choice Full Time Part Time Temporary Seasonal Educational Co-Op

Are you able to meet the attendance requirements of the position? YES NO *

Answering "yes" to either of the following questions does not constitute an automatic bar to employment.  Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you pleaded "guilty" or "no contest" to, or  been convicted of a crime? YES NO *
If "YES", please provide date(s) and details.

Driver's license number if driving is an essential job function.   State

Employment History:
Provide the following information for your past four (4) employers, assignments or volunteer activities, starting with the most recent.

From  To   Employer  

Job Title   Address  

Supervisor and Title   Telephone

Reason for Leaving

Hourly Rate/Salary:

                            Start $  Per      Final $  Per

Summarize the nature of work performed and job responsibilities.

From  To   Employer  

Job Title   Address  

Supervisor and Title   Telephone

Reason for Leaving

Hourly Rate/Salary:

                            Start $  Per      Final $  Per

Summarize the nature of work performed and job responsibilities.

From  To   Employer  

Job Title   Address  

Supervisor and Title   Telephone

Reason for Leaving

Hourly Rate/Salary:

                            Start $  Per      Final $  Per

Summarize the nature of work performed and job responsibilities.

From  To   Employer  

Job Title   Address  

Supervisor and Title   Telephone

Reason for Leaving

Hourly Rate/Salary:

                            Start $  Per      Final $  Per

Summarize the nature of work performed and job responsibilities.

Skills and Qualifications:
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background: IF JOB-RELATED

                            Name and Location                  Yrs Completed     Graduate?                         Course of Study

High School                 Make Choice YES NO                         

College                     Degree  Make Choice YES NO       Major

Other                                Make Choice YES NO                        

References: (You must have three (3))

               Name                                        Telephone            Years Known

*      *     *

 *      *     *

 *      *     *

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume' or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me..

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application is current for only 30 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.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract for employment for any specified period or definite duration.  I understand that no supervisor or representative of the employer is authorized  to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the  United States and that federal immigration laws require me to complete an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices.  No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status.  The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

    I UNDERSTAND I DO NOT UNDERSTAND *

I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.     YES NO *                                           
Date *

Note: It may take a minute or two to process your request.  Please do not click "Submitted" more than once; doing so may result in a duplicate request. 

 AN EQUAL OPPORTUNITY EMPLOYER