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A (*) denotes a required field.

General Information
*First Name: *Last Name: *Middle Initial:
*Email Address: *Home Phone (XXX-XXX-XXXX): Business Phone (XXX-XXX-XXXX):
May we contact you at work? Yes No
*Street Address: *City: *State: *Zip Code:
Position applying for: *Date available for employment (dd/mm/yyyy):
Employment Preference :
Full-Time Part-Time Either Days Evenings Weekends
Salary required: Preferred location:
*Are you over 18 years old? Yes No
*Are you legally eligible for employment in the United States? Yes No *Do you have a work visa? Yes No
*Have you previously applied for employment with us? Yes No
*Have you previously been employed by RuffaloCODY? Yes No
*Please indicate source of referral to RuffaloCODY:
RuffaloCODY Employee College Campus Recruiter Newspaper/Ad Referral Private Employment Agency Contacted on own Other

Education
High School Name and Location: Years completed (as yyyy): to Date graduated (as mm/yyyy):
Degree:
College/University: Years completed (as yyyy): to Date graduated (as mm/yyyy):
Degree:
Business/Technical: Years completed (as yyyy): to Date graduated (as mm/yyyy):
Degree:
Other: Years completed (as yyyy): to Date graduated (as mm/yyyy):
Degree:
List any Professional/ Technical Publications of which you are Author (title, place of publication, date). Patents or Professional Certifications/ Licenses that you hold:

Military History
*Have you ever served in the military? Yes No

Employment History
(Please provide complete and accurate full-time and part-time employment record. Beginning with your present or most recent employer). Simply attaching a resume will not be sufficient. If you do not have any employment history, please leave blank.
Employer Name 1
Street Address: City: State: Zip Code:
Starting date (as mm/yyyy): Ending date (as mm/yyyy):
Starting position: Ending position:
Starting salary: Ending salary:
Describe the responsibilities of your position:
Name of immediate supervisor: Phone (as XXX-XXX-XXXX):
May we contact? Yes No
Reason for leaving:
Employer Name 2
Street Address: City: State: Zip Code:
Starting date (as mm/yyyy): Ending date (as mm/yyyy):
Starting position: Ending position:
Starting salary: Ending salary:
Describe the responsibilities of your position:
Name of immedeiate supervisor: Phone (as XXX-XXX-XXXX):
May we contact? Yes No
Reason for leaving:
Employer Name 3
Street Address: City: State: Zip Code:
Starting date (as mm/yyyy): Ending date (as mm/yyyy):
Starting position: Ending position:
Starting salary: Ending salary:
Describe the responsibilities of your position:
Name of immedeiate supervisor: Phone (as XXX-XXX-XXXX):
May we contact? Yes No
Reason for leaving:
Employer Name 4
Street Address: City: State: Zip Code:
Starting date (as mm/yyyy): Ending date (as mm/yyyy):
Starting position: Ending position:
Starting salary: Ending salary:
Describe the responsibilities of your position:
Name of immedeiate supervisor: Phone (as XXX-XXX-XXXX):
May we contact? Yes No
Reason for leaving:
Additional employment information, skills/affiliations, specialized training or additional languages:

References
Please provide at least 2 references.
*Name: Occupation:
Address:
*Home/Work Phone (as XXX-XXX-XXXX): *Years known:
*Name: Occupation:
Address:
*Home/Work Phone (as XXX-XXX-XXXX): *Years known:
Name: Occupation:
Address:
Home/Work Phone (as XXX-XXX-XXXX): Years known:

RuffaloCODY APPLICANT STATEMENT

Please read carefully, click "I Agree" below to continue:

By signing below, I certify that misrepresentation or omissions in this application or in other information I give to RuffaloCODY, orally or in writing, may be cause for rejection or may be cause for subsequent dismissal if I am hired.

Have you ever pled guilty or no contest to, been convicted of, or received a deferred sentence with respect to any crime, other than a simple misdemeanor? (You are not required to provide information about a conviction which has been annulled, expunged or sealed by a court).
* Yes No

Note: Your conviction record will not necessarily disqualify you from employment.

I voluntarily authorize RuffaloCODY to make investigations of my person employment, and other related matters as may be necessary in arriving at any employment decision or verifying information related to my application. I hereby release from all liability all persons or entities supplying or collecting such information. If I am offered employment, I understand the offer is contingent on the outcome of any investigations or reference check satisfactory to RuffaloCODY.

If I am employed, I understand that I may be required to sign agreements regarding non-competition and regarding secrecy of communications and inventions, discoveries, or developments that I make, discover, or develop during my employment at RuffaloCODY.

In accordance with RuffaloCODY policy to maintain a drug-free work place, employees may be subject to drug testing throughout their employment in accordance with the law. I hereby agree to drug testing as required by RuffaloCODY policy and release RuffaloCODY from all liability arising from such testing.

I understand that my employment is contingent on my successful compliance with all employment eligibility verification requirements of the Immigration Reform and Control Act of 1986.

If I am employed, I understand that my employment is "at will" and for no definite period of time. Either RuffaloCODY or I may terminate my employment at any time, with or without cause and with or without notice. I further understand that my employment is at will regardless of any statement made by a RuffaloCODY agent or employee or in a RuffaloCODY policy, practice, handbook, program, or any other written or oral materials.

I understand that no representatives of RuffaloCODY other than the President of RuffaloCODY have the authority to make arrangements with me concerning the length of my employment. Such agreements must be in writing and signed by the President of RuffaloCODY.

*I agree to the terms stated above.

Resume

*Would you like to upload a resume? Yes No

RuffaloCODY and all affiliated companies afford equal opportunity in employment to all qualified persons regardless of race, color, religion, sex, age, national origin, sexual preference, disability, veteran status, or any other factors prohibited by law. Federal and state laws prohibit discrimination in employment practices.

Please submit my application for employment consideration.