RBA Staffing - Employment Application

Connecting skilled people to great jobs

Employment Application

Thank you for taking the time to complete our online employment application. Please fill out the application below as completely as possible. This application will take approximately 15 minutes to complete.

Are you at least 18 years of age and do you have the legal right to work in the United States? Yes No

Personal Information

First Name (Required) Please enter your first name
Middle Name
Last Name (Required) Please enter your last name
Nickname / Preferred Name
Street Address
Apartment
City
State
Zip Code (Numbers only) Please enter numbers only
Home Phone (Required) * – * – *
Other Phone * – * – *
Email Address Please enter your email address in the correct format

Resume

If you have a plain-text resume, paste it into the box below.

Education

Enter most recent only

Name of School (Required) If you don’t know the name of the school, enter “Not Applicable” or “NA” Please enter the name of the school you last attended
Type of School
Street Address
City
State
Zip Code (Numbers only) Please enter numbers only
Start Month
Start Year
End Month
End Year
Degree
Major Study Area
Other Studies

Recent Employment

List most recent first

Company Name (Required) If you don’t know the name of the company, enter “Not Applicable” or “NA” Please enter the name of the most recent company you worked for
Street Address
City
State
Zip Code (Numbers only) Please enter numbers only
Supervisor Name
Job Title
Job Duties
Start Month
Start Year
End Month
End Year
Start Wage Hourly rate or annual salary
End Wage Hourly rate or annual salary
May we contact this employer for a reference check?
Yes No

Company Name (Required) If you don’t know the name of the company, enter “Not Applicable” or “NA” Please enter the name of the previous company you worked for
Street Address
City
State
Zip Code (Numbers only) Please enter numbers only
Supervisor Name
Job Title
Job Duties
Start Month
Start Year
End Month
End Year
Start Wage Hourly rate or annual salary
End Wage Hourly rate or annual salary
May we contact this employer for a reference check?
Yes No

Availability

Are you willing to work temporary?
Yes No
Are you looking for a full-time career position?
Yes No
Are you looking for contract positions?
Yes No
When are you available to start?
What weekday hours are you available?
What weekend hours are you available?
How many hours are you willing to work in a week?
Are you willing to work overtime? Yes No
What is the minimum pay you desire? (Hourly rate or annual salary)
How much notice will you need if a position is offered to you?
How many miles are you willing to travel to a position?

I certify that the statements I have made are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.

When I am employed I agree that if at any time I make claims for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of employer's selection, at employer's expense, as often as may be requested.

I also agree that if I am employed, now or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination. I understand the term of my employment shall be limited to the duration of any assignment that I accept.

I am aware that Public Law 91-508, known as the Fair Credit Reporting Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information as to the nature and scope of the inquiry or any report which is produced.

I understand that I am applying for temporary or contract assignments. The completion of this application process shall constitute a conditional offer of employment subject to my availability and the availability of customer assignments calling for the skill and qualifications that I possess, and I agree to consider acceptance of such assignments.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.

Initials: (Letters only) Please enter your initials

“RBA has been very helpful with the entire process of bringing Temps onboard with EBS-RMSCO.”
- Amy L. Spotts, EBS-RMSCO, Inc.

“I have been working with RBA Staffing for six years. They exceed my expectations in the time it takes them to place candidates as well as the quality of the candidates.”
- SPX