The Rutter Organization

Thank you for considering a career with The Rutter Group, Inc. Please fill out application completely.

You must fill out all of the fields on the application. If a question does not apply to you, please indicate by putting NA in the empty field.

Name:
Last First MI

Address:


City State Zip

Phone:

E-mail:

SSN:
(Please include dashes)

Can you verify your legal right to work
in the United States?                                             Yes    No

What position are you applying for?
When can you start working?
What is your salary requirement?
Work Preference:                                   Part Time Full Time

Can you perform the essential
functions of the position in which
you are applying?                                  Yes         No

Qualifications: Please tell us about your skills and experience.

Do you up to date with all required licenses?    Yes    No

         If yes, please specify type of license
         Expiration Date:

Have you applied at The Rutter Group
before?                                      Yes    No

           If so when?
           What position?

Have you been convicted of a crime other
than minor traffic violations or are you
awaiting trial for a crime?                                   Yes    No

If yes, please give dates, location, nature and disposition of the convictions: Answering "Yes" will not necessarily disqualify an applicant from employment.

Do you have relatives employed by
The Rutter Group? Yes No

If yes, please give names, points, relationships:

Education:
Please list the name and address of school and check highest grade completed.

Elementary Grade Completed: 4 5 6 7

High School Grade Completed: 9 10 11 12

College/University Grade Completed: 1 2 3 4

Graduate School Yes No

Language Capabilities: List languages and check your capabilities. Read Write Speak
Read Write Speak
Read Write Speak
Read Write Speak

Work History Beginning with your most recent experience, list below all present and past employment for the last Ten (10) years. Include summer or part-time employment or any unemployed or self-employed periods. Show dates and locations.
Employer #1 Name & Address Supervisor:
Worked From: (month, year)	Worked To: (month, year)
Starting Salary: (specify hourly/yearly)	Ending Salary: (specify hourly/yearly)
Job Title: Work Phone: Job Description: Reason for leaving? Resigned Terminated Layoff Explain:

Employer #2 Name & Address
Supervisor:

Worked From: (month, year)
Worked To: (month, year)

Starting Salary: (specify hourly/yearly)
Ending Salary: (specify hourly/yearly)

Job Title:     Work Phone:

Job Description:

Reason for leaving?          Resigned    Terminated    Layoff
                 Explain:


Employer #3 Name & Address
Supervisor:

Worked From: (month, year)
Worked To: (month, year)

Starting Salary: (specify hourly/yearly)
Ending Salary: (specify hourly/yearly)

Job Title:     Work Phone:

Job Description:

Reason for leaving?         Resigned    Terminated    Layoff
              Explain:


References:
Give three (3) references (not relatives) or former employers whom you have known for at least five (5) years.
Reference # 1
Name
Address Phone #
Reference # 2
Name
Address Phone #
Reference # 3
Name
Address Phone #

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