Employment Application

Employment Applicant Info

Last Name *

First Name *

Middle Initial *

Date of Application *

Address *

City *

State *

ZIP *

Cell # *

Home #

Email Address *

General

Position Applying for:

Have you ever been employed by RTC Networks before? *YesNo

If Yes, List date(s) and job title(s)

Are you related to an RTC Networks employee or Board of Director? *YesNo

If Yes, List Name(s) and relationship(s)

Are you at least 18 years old? *YesNo

May we contact your current employer for references? *YesNo

Do you have a valid drivers license? *YesNo

Have you ever been convicted of a crime, excluding misdemeanors and summary which has not been annulled, expunged or sealed by court?? *YesNoA yes response does not automatically disqualify your application.

Education

High School

Graduated?YesNoHigh School

High School Diploma or CertificateDiplomaCertificate

College/University

Major Studies

Graduated?YesNoCollege/University

Degree, Diploma, License or CertificateCollege/University

Vocational, Business, Other

Major Studies

Graduated?YesNoVocational, Business, Other

Degree, Diploma, License or CertificateVocational, Business, Other

List any Professional Designations

Other Special Knowledge, Skills or Qualifications

Computer Skills (Hardware/Software)

Employment History

Start with your present or most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

Employer Name

Street Address

City

State

ZIP

Employed from

Employed until

Starting Salary

Ending Salary

Supervisor Name

Supervisor Phone #

Supervisor Email Address

Job Title

Reason for Leaving

Work Performed/Job Responsibilities

Employer Name

Street Address

City

State

ZIP

Employed from

Employed until

Starting Salary

Ending Salary

Supervisor Name

Supervisor Phone #

Supervisor Email Address

Job Title

Reason for Leaving

Work Performed/Job Responsibilities

Employer Name

Street Address

City

State

ZIP

Employed from

Employed until

Starting Salary

Ending Salary

Supervisor Name

Supervisor Phone #

Supervisor Email Address

Job Title

Reason for Leaving

Work Performed/Job Responsibilities

Employer Name

Street Address

City

State

ZIP

Employed from

Employed until

Starting Salary

Ending Salary

Supervisor Name

Supervisor Phone #

Supervisor Email Address

Job Title

Reason for Leaving

Work Performed/Job Responsibilities

References

Name *Reference #1

Occupation

Years Known

Email Address

Phone *

Name *Reference #2

Occupation

Years Known

Email Address

Phone *

NameReference #3

Occupation

Years Known

Email Address

Phone

Certification & Authorization

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS EMPLOYMENT APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) MAY RESULT IN MY NOT BEING CONSIDERED FOR EMPLOYMENT, AND IF NOT DISCOVERED BY RESERVATION TELEPHONE COOPERATIVE UNTIL AFTER MY BECOMING EMPLOYED, IS GROUNDS FOR, AND MAY RESULT IN MY IMMEDIATE TERMINATION.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, or pregnancy, as well as any qualified individuals with a disability, and any other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the Employer from all liability that might result from making an investigation.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Sign Here

Signature of U.S. person *By entering your name on the line, you are effectively providing your signature.

Date *

Comments

This institution is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632‐9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250‐9410, by fax (202) 690‐7442 or email at program.intake@usda.gov.

Equal Opportunity Data Collection

The following information is requested by the Federal Government for certain types of loans in order to monitor compliance with equal opportunity. You are not required to furnish this information but are encouraged to do so. The law requires that we neither discriminate on the basis of this information nor on whether you choose to furnish it. If you choose not to furnish it Federal regulations require us to note race/ethnicity on the basis of visual observation or surname. If you do not wish to furnish the information please check the box below.

Equal Opportunity Data Collection *I do not wish to furnish this information.I do wish to furnish this information, answered below.

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Additional Documents (optional)

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Employment Applicant Info

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Employment History

References

Certification & Authorization

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