Russellville Steel Company, INC.

280 Steel City Lane, Russellville, AR72802

P.O. Box 1538, Russellville, AR72811

Ph 479/968-2211 Fax 479/9683486

APPLICATION FOR SHOP EMPLOYMENT

(Complete front and back)

Name:______

Address:______City:______State:_____ Zip:______

Phone Numbers: Home:______Message:______

Social Security No:______Birth Date:______

Position Desired:______Pay Expected:______

Will you work: Overtime______4 Day Shift:______Weekend Shift:______Nights:___

Date available to begin work:______

Please check the following equipment/machinery you can operate:

Forklift:____ Punch press:______Overhead crane:______Band saw:______Plate shear:______Brake:______CNC controlled machines:______commercial spray paint equipment:______

Please list any qualifications you possess specific to the position to which you are applying:______

So you have and friends or relatives who are currently employed by us? ______

If so, who? ______

Do you now or have you ever served in the U.S. Armed Forces?______

IF so, what branch:______When:______

Have you been convicted of a felony within the last ten (10) years?______

Can you perform the minimum requirement for the position you are applying without reasonable accommodation being made by the employer?______

PRIOR EMPLOYMENT HISTORY: (start with most recent employer)

  1. Company Name:______

Phone and Address:______

Job Title:______Starting Pay:______Ending Pay:______

Starting Date:______Ending Date:______

Reason for Leaving:______

  1. Company Name:______

Phone and Address:______

Job Title:______Starting Pay:______Ending Pay:______

Starting Date:______Ending Date:______

Reason for Leaving:______

  1. Company Name:______

Phone and Address:______

Job Title:______Starting Pay:______Ending Pay:______

Starting Date:______Ending Date:______

Reason for Leaving:______

EDUCATION:

High School:______Grade Completed:______

College:______Degree/Yrs Completed:______

Trade School:______Certificate rec’d:______

PERSONAL REFERENCES: (list three people other then family members)

Name:______Occupation:______Phone:______

Name:______Occupation:______Phone:______

Name:______Occupation:______Phone:______

Russellville Steel Company reserves the right to contact your prior employers and references. Please list any that you do not want us to contact:______

Our employment practices are to provide that all individuals be recruited, hired, assigned, advanced, compensated and retained on the basis of their qualifications and treated equally in these and all other respects, without regard to race, religion, color, sex, age, national origin, handicap or veteran status.

I, (applicant), hereby give consent to any and all prior employers of mine to provide information with regard to me employment with prior employers to Russellville Steel Company, Inc.

The information provided by you in this application for employment must be true and correct. If employed, and misstatements or omission of fact on the application may result in your dismissal. Further, any offer of employment by this company does not create a contractual obligation upon the employer to continue to employ you in the future.

Signature of Applicant:______Date:______