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Employment Application

An Equal Opportunity Employer

9/12

 

 

 

 

 

CONSULTANT/SALES REPRESENTATIVE APPLICATION FORM

Please print clearly and fill out completely.

 

PERSONAL INFORMATION Date: __________________

Name _____________________________________________ SSN: ___________________________________

Current Address: ____________________________________________________________________________

City: ___________________________________________________ State: _______ Zip: ____________________

Permanent Address: __________________________________________________________________________

City: _______________________________________________________State: _______ Zip: _________________

Birthdate: __________________ Telephone: ________________________ Best time to call: __________________

Alternative Telephone: _______________________________ E-Mail: ____________________________________

Date you can start work: ________________________________________________________________________

Are you currently employed? YES NO

May we contact your current employer? YES NO Who should we ask for: ______________________________

Have you ever applied to Renaissance before? YES NO If yes, when? _________________________

EDUCATION

Circle the number of years you have attended school:

1 2 3 4 5 6 7 8 9 10 11 12 BA/BS MA/MS PhD

High School Attended: _________________________________________________________________________

Address: ____________________________________________________________________________________

Did you graduate? YES NO Year: ______________________

Did you attend college or university? YES NO

Degree(s): ___________________________________________________________________________________

Did you attend a Trade School? YES NO

Degree/Certification: ___________________________________________________________________________

SKILLS

Please indicate in which of the following you have experience or skills:

  • Computer use: Limited ___ Intermediate ___ Proficient ___ Advanced ___
  • E-mail/Web use: Limited ___ Intermediate ___ Proficient ___ Advanced ___
  • Computer Ration Program: Limited ___ Intermediate ___ Proficient ___ Advanced ___
  • Indicate ration program(s) are you most familiar with: ___________________________________________
  • Other software/hardware familiar with: _______________________________________________________
  • Training in computer program(s): ___________________________________________________________
  • List any other special skills, activities, hobbies, experiences or other information you feel would be helpful in evaluating your qualifications (use an additional sheet if necessary). Please include professional memberships and organizations you have been involved with.

 

Page 2

EXPERIENCE

Indicate where you have worked, starting with most current employer. Attach a current resume with this application.

Business Name: __________________________________________________________ From: _____ To______

Address: ____________________________________________________________________________________

Telephone: ________________________ May we contact them? YES NO

Job title: _____________________________________________ Supervisor: ______________________________

Starting Salary: __________________ Ending Salary: _______________

Description of duties:

 

 

Reason for leaving:

Business Name: __________________________________________________________ From: _____ To______

Address: ____________________________________________________________________________________

Telephone: ________________________ May we contact them? YES NO

Job title: ______________________________________________ Supervisor: _____________________________

Starting Salary: __________________ Ending Salary: _______________

Description of duties:

 

 

Reason for leaving:

Business Name: ___________________________________________________________ From: _____ To_____

Address: ____________________________________________________________________________________

Telephone: ________________________ May we contact them? YES NO

Job title: ______________________________________________ Supervisor: _____________________________

Starting Salary: __________________ Ending Salary: _______________

Description of duties:

 

 

Reason for leaving:

Business Name: ___________________________________________________________ From: _____ To_____

Address: ____________________________________________________________________________________

Telephone: ________________________ May we contact them? YES NO

Job title: ______________________________________________ Supervisor: _____________________________

Starting Salary: __________________ Ending Salary: _______________

Description of duties:

 

 

Reason for leaving:

For additional space please add sheet(s) as needed

Page 3

 
REFERENCES

Please do not use any family member.

 

 

Name: ______________________________________________________________________________________

 

Relationship: ________________________________________ Years known: ____________

 

Address: ____________________________________________________________________________________

 

Telephone: ________________________________________ E-mail: ____________________________________

 

Name: ______________________________________________________________________________________

 

Relationship: ________________________________________ Years known: ____________

 

Address: ____________________________________________________________________________________

 

Telephone: ________________________________________ E-mail: ____________________________________

 

 

Name: ______________________________________________________________________________________

 

Relationship: ________________________________________ Years known: ____________

 

Address: ____________________________________________________________________________________

 

Telephone: ________________________________________ E-mail: ____________________________________

 

 

STATEMENT OF VERIFICATION

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

 

Signature: _________________________________________________________ Date: _________________

 

Submit a current copy of your current resume along with this completed application to:

 

RENAISSANCE NUTRITION, INC.

P.O. Box 229 - 339 Frederick Rd.

Roaring Spring, PA 16673

1-800-346-3649

rennut@rennut.com