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FOR OFFICE USE ONLY
TELEPHONE 530-824-0644
Applicant: We appreciate your interest in our organization and are sincerely interested in your qualifications. For a clear understanding of your background and work history, please complete this application thoroughly and in a detailed manner for assisting us in possible future hiring or upgrading. Application will remain active for six months.
DATE OF APPLICATION: _________________________
SOCIAL SECURITY NO.__________________________________
_____________________________________________________________________ NAME _______ LAST FIRST MI
PRESENT ADDRESS _____________________________________________________________________ STREET CITY STATE ZIP
HOME TELEPHONE NUMBER (_____) ________________ CELL PHONE NUMBER (_____) ____________
DATE OF BIRTH _____-_____-____ (mm/dd/yyyy)
PERMANENT ADDRESS (IF DIFFERENT FROM ABOVE) ______________________________________ EMERGENCY CONTACT NAME ______________________________
EMERGENCY CONTACT TELEPHONE NO. (_____) _________________ (Other than home phone number)
POSITION(S) APPLYING FOR: _______________________________________________
ACCEPTABLE SALARY _____________________________ (Yearly or Hourly)
OTHER POSITIONS QUALIFIED FOR OR INTERESTED IN ______________________________________
ARE YOU WILLING TO WORK EITHER NIGHT OR DAY SHIFTS? YES: _________ NO: __________
WHAT DATE ARE YOU AVAILABLE TO REPORT TO WORK? ____________________________________
PERSONAL INFORMATION
CIRCLE THE NUMBER OF SCHOOL YEARS ATTENDED: 1 2 3 4 5 6 7 8 9 10 11 12 COLLEGE: 1 2 3 4 5 COMPLETE THE APPLICABLE INFORMATION BELOW.
If needed, use back of this sheet for additional business experience information. PHYSICAL / PERSONAL DATA HEIGHT __________ WEIGHT ________ DO YOU WEAR GLASSES? __________ PRESENT HEALTH
CONDITION ____________
DATE AND CLASS OF LAST PHYSICAL _______________ WHAT PURPOSE __________ DID YOU PASS Yes ____ No ____
LIST ANY CURRENT PHYSICAL DEFECTS ___________________________IN PAST TWO YEARS _________________________________________________________________________________
HAVE YOU EVER SUFFERED ANY SERIOUS INJURY OR ILLNESS? __________________________________________________ WHAT IDENTIFYING MARKS OR SCARS DO YOU HAVE? ___________________________________________________________
______________________________________________________________________________________ THIS SECTION FOR PILOTS NOTE: ALL FLYING TIMES MUST BE SUBSTANTIATED BY CERTIFIED LOG OR RECORD. THIS SECTION FOR MECHANICAL AND RADIO CERTIFICATIONS THIS SECTION FOR ADMINISTRATIVE AND CLERICAL
PILOT CERTIFICATE No. __________________ RATINGS: __________________________________________ ACTUAL TOTAL HOURS _________ NIGHT __________ CROSS COUNTRY ___________ INSTRUMENT ____________ SIMULATED INSTRUMENT __________ MULTI-ENGINE __________ FIRST PILOT ___________ CO-PILOT _____________ TOTAL FLIGHT TIME AS FIRST PILOT BY TYPES OF AIRCRAFT _____________________________________ U.S. MILITARY PILOT RATING HELD ____________________________________________________________ TRAINING IN METEROLOGY __________________________ NAVIGATION ____________________________ MECHANICAL TRAINING AND EXPERIENCE _____________________________________________________ NATURE AND DATE OF LICENSE WAIVERS ______________________________________________________ LIST: (CIRCUMSTANCES AND DATE) (1) ACCIDENTS: _________________________________________________________________________ (2) VIOLATIONS: _________________________________________________________________________
MECHANICAL LIST LICENSES: AIRFRAME ___________________________ POWERPLANT ___________________________ GIVE ORIGINAL DATE OF ISSUANCE ARE YOU WILLING TO OBTAIN A COMPLETE SET OF TOOLS? ________________________________________ LIST TYPE OF AIRCRAFT, ENGINE AND EQUIPMENT EXPERIENCE: (DISTINGUSH IF LINE MAINTENANCE OR OVERHAUL WORK) _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ RADIO LIST ANY VALID RADIO LICENSE(S) ____________ CLASS ____________ LICENSE NO. ___________________ DATE AND PLACE OF ISSUE: ____________________________________________________________________
KEYBOARD OR TYPING SPEED _________-WPM LIST ALL OFFICE EXPERIENCE (DUTIES) THAT MIGHT BE A FACTOR IN SELECTING YOU FOR EMPLOYMENT: _____________________________________________________________________________________
REFERENCES (PLEASE PROVIDE ALL INFORMATION REQUESTED)
AGREEMENT (PLEASE READ COMPLETELY BEFORE SIGNING) I HEREBY AUTHORIZE RAINBOW AVIATION (HEREIN REFEREED TO AS COMPANY) AND ALSO AUTHORIZE AND REQUEST EACH FORMER EMPLOYER AND PERSON, FIRM, OR CORPORATION GIVEN ABOVE AS A REFERENCE, TO ANSWER ANY QUESTIONS THAT MAY BE ASKED AND TO GIVE ANY INFORMATION THAT MAY BE SOUGHT IN CONNECTION WITH THIS APPLICATION OR CONCERNING ME, MY WORK HABITS, CHARACTER, OR SKILL. I HEREBY AUTHORIZE THIS COMPANY TO FURNISH, AT ANY TIME IN THE FUTURE, UPON REQUEST OF ANY PARTY OR OF THE SURETY COMPANY BY WHICH I MAY BE BONDED, REPORTS AND ANY INFORMATION RELATIVE TO MY RECORD AND SERVICES WITH AND FOR THIS COMPANY. I AGREE TO SUBMIT MYSELF, UPON REQUEST, FOR PHYSICAL EXAMINATION BY THE COMPANY’S PHYSICIAN AND UNDERSTAND THAT FAILING TO PASS SAID EXAMINATION I WILL NOT BE RETAINED IN THE COMPANY’S SERVICE. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE THAT IF AT ANY TIME I SHALL MAKE CLAIMS AGAINST THE COMPANY FOR PERSONAL INJURIES, I WILL SUBMIT TO EXAMINATION BY PHYSICIANS OF THE COMPANY’S SELECTION, AS OFTEN AS MAY BE REQUESTED. IN FURTHER CONSIDERATION OF MY EMPLOYMENT, I AUTHORIZE THE COMPANY, ITS SUCCESSORS, AGENTS, ASSIGNS, CUSTOMERS AND PURCHASERS TO COPYRIGHT SELL, USE AND PUBLISH ALL NEGATIVES MADE OF ME AT ANY TIME AND ALL PHOTOGRAPHIC PRINTS OR OTHER REPRODUCTS, FROM ALL OR ANY PART THEREOF, INCLUDING MAKING ALTERING, OR ADDING TO THE SAME, FOR PUBLICATION, ADVERTISING, TESTIMONIAL, AND ANY AND ALL COMMERCIAL PURPOSES WHATSOEVER WITH OR WITHOUT USING MY NAME. IF THE COMPANY IS SUBJECT TO AND IS OPERATING UNDER THE WORKER’S COMPENSATION LAW, EITHER AS A SELF-INSURER OR BY PROVIDING FOR COMPENSATION THROUGH SOME INSURANCE CARRIER, I AGREE IN CASE OF INJURY, TO ACCEPT COMPENSATION WHERE APPLICABLE, AND I HEREBY WAIVE ALL ACTIONS AT LAW FOR DAMAGES. SHOULD I BE GIVEN EMPLOYMENT BY RAINBOW AVIATION, EITHER THE POSITION APPLIED FOR OR SOME OTHER POSITION, NOW OR HEREAFTER, I HEREBY AGREE THAT SUCH EMPLOYMENT MAY BE TERMINATED BY YOU AT ANY TIME WITHOUT ADVANCE NOTICE AND WITHOUT LIABILITY TO ME FOR WAGES OR SALARY, EXCEPT SUCH AS MAY HAVE BEEN EARNED AT THE DATE OF TERMINATION. I FURTHER AGREE AND UNDERSTAND THAT THE COMPANY PERSONNEL MANUAL IS FOR GUIDANCE AND CAN BE CHANGED AT ANY TIME AT THE DISCRETION OF THE COMPANY. THE FOREGOING APPLICATION SHALL BE CONSTRUED TO APPLY TO ALL POSITIONS THAT I MAY HEREAFTER HOLD WITH RAINBOW AVIATION, THOUGH THE PARTICULAR POSITION FOR WHICH I NOW APPLY IS _____________________________________________, AND UPON MY ENROLLMENT, I AGREE TO PROMPTLY FAMILIARIZE MYSELF WITH ALL GOVERNMENTAL AND COMPANY RULES AND REGULATIONS APPLYING TO SUCH POSITION OR POSITIONS AND TO FAITHFULLY ABIDE BY THEM. I UNDERSTAND THAT APPOINTMENTS TO POSITIONS ARE INITIALLY ON A PROBATIONARY BASIS. THE PERIOD OF EMPLOYMENT DEPENDING UPON MY USEFULNESS TO RAINBOW AVIATION. THE COMPANY PROBATIONARY PERIOD IS SET AT 90 DAYS; HOWEVER, WHEN THE COMPANY DEEMS APPROPRIATE, IT CAN BE EXTENDED AS THE COMPANY DEEMS APPROPRIATE. I HEREBY CERTIFY THAT THE ANSWERS GIVEN ON THIS APPLICATION ARE FULL AND TRUE AND I AGREE BY SIGNING BELOW THAT ANY MATERIAL MISSTATEMENT OF FACTS SHALL BE GROUNDS FOR DISMISSAL.
DATE: ________________________________________ SIGNATURE:
_______________________________________________________ (SIGN IN INK) INTERVIEWED BY: ____________________________ DATE: _______________________________
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