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Job Application


1065 N. 1150 W. Middlebury, IN 46540
Phone: 574-825-4032 | Fax: 574-825-4060

Employee Application

Today's Date:

Position Applying for:

Location Applying for:

PLEASE TYPE OR PRINT. Complete the entire application. You may attach a resume, but you must still complete all questions or your application will be deemed incomplete and may not be considered.

Employee Information

Last Name

First Name

Middle Name

Street Address

City

State

Zip

Home Phone

Cell

Email

Types of Positions
Customer ServiceProductionThird ShiftOtherIf Other, describe:

Are you 18 years of age or older? YesNo

If no, what is your current age?

Are you willing to work 40 hours per week? YesNo

If not, how many?

Are you willing to work every other Saturday? YesNo

How did you learn about this employment opportunity?
Ad in newspaperAd in MagazineJob Bulletin (posting)/Walk-inReferral by EmployeeWebsiteOther If other,

What is your possible starting date?

What is your desired wage?

If selected for employment, are you willing to submit to a pre-employment drug screening test? YesNo

Employment History

List the most recent employment first. Include summer or temporary jobs.

Employer Name

Pay

Per

Employer Address

City

State

Zip

Position title/duties, skills:

Supervisor:

Telephone:

Start date:

End date:

Reason for leaving:

Employer Name

Pay

Per

Employer Address

City

State

Zip

Position title/duties, skills:

Supervisor:

Telephone:

Start date:

End date:

Reason for leaving:

Employer Name

Pay

Per

Employer Address

City

State

Zip

Position title/duties, skills:

Supervisor:

Telephone:

Start date:

End date:

Reason for leaving:

Skills & Qualifications

Briefly describe why you think you could be an asset at Rise' n Roll. Please list any technical skills, clerical skills, trade skills, etc., relevant to this position.

About Yourself

Tell us about yourself. Where do you see yourself in the future?

What jobs have you enjoyed the most? Why? Least? Why?

Do you have any outside interests or activities that would prevent you from being on time and at work everyday?

What can you offer Rise' n Roll? What are your strengths? Weaknesses?

Why are you interested in Rise' n Roll?

Thank you for inquiring and completing this application. Not all applications will be accepted. However, each application will be reviewed and the applicant will be notified within 2 weeks if the application fits the job opening or possibly kept back for further openings. If your application is accepted, pay, hours, and days will then be discussed.