NW Regional – Seattle Office Employment Application

• Last Name * :
• First Name * :
• Middle Name * :
• Business Telephone:
• Home Telephone * :
• Email * :

Present Address:

• Address * :
• City * :
• State and Zip * :

Permanent Address (if different from present address):

• Address :
• City :
• State and Zip :

Employment Desired :

• Position applying for * :

Are you applying for:

• Regular full-time work * :YesNo
• Regular part-time work* :YesNo
• Temporary part-time work* :YesNo
• What days and hours are you available for work * :
• If applying for temporary work, during what period of time will you be available:
• Are you available for work on weekends * :YesNo
• Would you be available to work overtime, if necessary * :YesNo
• If hired, on what date can you start work * :
• Salary desired * :
• Would you be available to travel, if necessary * :YesNo

Personal Information:

Have you ever applied to or worked for ARI before * :YesNo
If yes, when?
Do you have any friends or relatives working for ARI * :YesNo
If yes, state name(s) and relationship :
Why are you applying for work at ARI? *
If hired,would you have a reliable means of transportation to and from work * :YesNo
Are you at least 18 years old * :YesNo(If under 18, hire is subject to verification that you are of minimum legal age.)
If hired, can you present evidence of your citizenship or proof of your legal right to live and work in this country * :YesNo
Are you able to perform the functions of the job for which you are applying * :YesNo

If no, describe the functions that cannot be performed:

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Are you able to perform all other duties of the job for which you are applying * :YesNo

If no, describe the functions that cannot be performed

(Note: Hire may be subject to passing a medical examination, and to skill and agility tests.)

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offense that are more than two years old need not be listed) * :YesNo
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
If yes, state nature of the crime(s), when and where convicted and disposition of the case
• Are you currently employed * :YesNo
• If so, may we contact your current employer:YesNo

Education, Training and Experience

• Many of our customers (clients) do not speak English. Do you speak, write or understand any foreign languages * : YesNo
• If yes, which language(s)?
• Do you have any other experience, training, qualifications or skills which you feel make you especially suited for work at ARI? If so, please explain:

Employment History:

List below all present and past employment starting with your most recent employer (last 10 years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.

• Name of Employer:

Address:

• No :
• Street :
• City :
• State :
• Zip :

• Type of Business :
• Telephone No :
• Your Supervisors Name :
• Your Position and Duties
• Date of Employment:
• Weekly Pay:
• Reason for Leaving:

Military Service:

• Have you obtained any special skills or abilities as the result of service in the military * : YesNo
• If so, describe:

References

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name * :
Address
No * :
Street * :
City * :
State * :
Zip * :
Occupation * :
Telephone No * :
Number of Years Acquainted * :
Name * :
Address:
No * :
Street * :
City * :
State * :
Zip * :
Occupation * :
Telephone No * :
Number of Years Acquainted * :
• Name * :

Address:

• No * :
• Street * :
• City * :
• State * :
• Zip * :
• Occupation * :
• Telephone No * :
• Number of Years Acquainted * :

Safety Training

Have you ever worked:

• On supported scaffold * :YesNo
• If yes, how many years:
• On suspended scaffold * :YesNo
• If yes, how many years:
• Operating boom, scissors, or forklift * :YesNo
• If yes, how many years?
• Operating powder-actuated tools (e.g., Hilti) * :YesNo
• If yes, how many years?
• In a confined space * :YesNo
• If yes, how many years?
• Do you have any of the following certification cards or certificates (Please check that apply):OSHA 10First Aid/CPRSuspended ScaffoldSupported ScaffoldConfined SpaceFall ProtectionBoom, Scissors, Forklift