APPLICATION OF EMPLOYMENT OF WORK AT HIGHSMITH ENTERPRISES, INC.
DBA ROYALL SERVICES

Equal Opportunity Employer

Date

 PERSONAL INFORMATION
Name Phone
Address Cell Phone
City Previous Address
State City
Zip Code State
 IDENTIFICATION
Social Security # Other ID
Drivers License Number State

Any Violations? Type
Have You Been Convicted of A Crime? When?
Explain
 EMPLOYERS
Company Date Start

Address Stop

City Phone #
State Supervisor
Position Pay Rate
Why Did You Leave?
Company Date Start
Address Stop
City Phone #
State Supervisor
Position Pay Rate
Why Did You Leave?
Company Date Start
Address Stop
City Phone #
State Supervisor
Position Pay Rate
Why Did You Leave?
 WORK HISTORY RELEASE AUTHORIZATION

By checking this box, I am authorizing the release of my employment history and any information concerning my employment with any company or entity where I am or have been employed. This information is to be released to Highsmith Enterprises, Inc. DBA Royall Services.
 AVAILABILITY TO WORK
Morning
Afternoon
Evening
Weekend
 EDUCATION
Jr. High City
Grade Completed State
Date    
Sr. High City
Grade Completed State
Date    
College City
Grade Completed State
Date    
Other Training City
Grade Completed State
Date    
 PHYSICAL RECORD
Do you have any physical conditions that may limit your ability to perform the job you applied for?

If you have a limitation, what is it?

Have you filed any workman compensation claims?

If you have filed any claims, why?

Are you presently under a physicians care?

Why?

In case of an emergency notify (Name & Phone)

 PERSONAL REFERENCES
Name State
Address Phone #
City    
Name State
Address Phone #
City    
 IN CASE OF EMERGENCY NOTIFY
Name State
Address Phone #
City    
Relation    
 AUTHORIZATION
By checking this box, I authorize the investigation of all statements contained in this application. I understand that any misrepresentation or omission of facts requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of wages/salary, be terminated at any time without any previous notice.

    
HIGHSMITH ENTERPRISES, INC. DBA ROYALL SERVICES IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF NON-DISCRIMINATION IN EMPLOYMENT ON BASIS, INCLUDING RACE, CREED, COLOR, AGE, SEX, RELIGION OR NATION ORIGIN.