Application for Employment Complete this online application, print for your records and click the Submit Form button at the bottom of this page.

Name: Last:   First:   Middle Name:  

Address: Number: Street: City: State: Zip Code:

Telephone:  Social Security Number:

Previous Address: Number: Street: City: State: Zip Code:

Are you less than 18 years of age? Yes   No  

If yes, can you furnish an Educational Certificate? Yes     No  

Are you a U.S. Citizen? Yes    No        If no, are you a lawfully admitted Alien eligible for employment?   Yes    No  

Have you served in the military? Yes    No          
If so, which branch?   Army    Navy    Airforce  Marines    Coast Gard   

Dates served:  From     To    

Did you receive an honorable discharge?  Yes   No    
If no, please explain:

Are you employed now? Yes    No  

May we contact your present employer? Yes    No  

Are you layed off and subject to recall? Yes    No   

On what date would you be available for work? 

Are you available to work to : Full Time   Part Time    Shift Work    Temporary  

Personal interests and hobbies:

Indicate what foreign languages you speak, read and/or write: Fluently Good Fair Speak Read Write List professional, trade, or business activities and offices held (exclude those which indicate race, color, religion, or national origin):

Indicate what foreign languages you speak, read and/or write:

List professional, trade, or business activities and offices held (exclude those which indicate race, color, religion, or national origin):

Give name, address, telephone number and occupation of three references who are not related to you and are not previous employers.

Have you been convicted of a felony within the last 5 years? Yes No

If yes, please explain:

Employment Experience

Please account for all of your time since completing school. Include military, service assignments and significant volunteer activities. (Please list most recent first.)

Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience:

Applicant Data Record

Referral Source:     Advertisement  Friend  Relative  Walk-In  Employment Agency  Direct Recruitment  Other

Name:     Last:  First:  Middle Name:  

Address:   Number:  Street:  City:  State:  Zip Code:

Affirmative Action Survey:
Government agencies require periodic reports on the sex, ethnicity, disabled and veteran status of applicants. This data is for analysis and affirmative action only. Submission of this information is voluntary.

Check one:  Male    Female  

Choose one:  White    Black     Hispanic     American Indian/Alaskan Native      Asian/Pacific Islander  

Special Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals with Physical or Mental Disabilities:

Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974, which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era. Government contractors are also subject to Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified disabled individuals.

If you are a disabled veteran, Vietnam Era Veteran, or have a physical or mental disability, you are invited to volunteer this information. The purpose of this is to provide information regarding proper placement and appropriate accommodation to enable you to perform your job in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.

If you wish to be identified, please sign below.

            Disabled Individual         Disabled Veteran        Vietnam Era Veteran  

Signed:

For Personnel Department Use Only

State any additional information you feel may be helpful to us in considering your application:

Agreement

Please read and sign below
The facts set forth in my application for employment are true and complete. I understand that if employed, false statements or misleading information given in my application or interview(s) shall be considered sufficient cause for dismissal.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand that if offered employment, I must meet job-related physical requirements established by the Company and furnish acceptable evidence of appropriate job-related qualifications including, but not limited to, academic transcripts, licenses, and date of birth. I understand, also, that I am required to abide by all rules and regulations of the Company.

Employment with this Company is terminable at the will of either the employer or employee and no contract of employment, neither expressed, implied, or otherwise, is created.

Signature of Applicant:        Date:  

For Personnel Department Use Only

If you wish to submit a resume for us to consider along with your application, click on the following email link to create a new email, enter "Resume" in the subject, attach your resume to to the message and send the message, then submit the application form.

Email address for resume:  jobs@renova.com

Print this form from your browser  to get a copy for your records before submitting.  

                           15 Wellstown Road, Ashaway, RI 02804 | Ph: 800-635-6682 | Fax: 401-682-1860