Last Name:   First Name:   Middle Initial:

E-Mail Address:

Address:

City: County: State: Zip Code:

Phone:   Best Time to Call: MorningAfternoonEvening  

I am: Under 18Over 18  
If under 18 can you provide the necessary work certificate at the time of employment? YesNoN/A

Have you ever been convicted of a crime other than a traffic violation? YesNo  
If yes give all dates and reasons for conviction (a conviction will not necessarily disqualify you from the job):

Were you ever employed by Rally: YesNo  
If yes, what location?
Dates of Employment: From: To:
Reason for Leaving:

How did you hear about Rally: Web-SiteNewspaperReferralOther  
Name of web-site, newspaper, referral, or other:

Tell us about your availability:
Days and hours are subject to change. Rally cannot guarantee that employees will be assigned desired hours.
Date available to begin work:

Weekdays: YesNo	1st Shift (6am-2pm): YesNo
Weekends: YesNo	2nd Shift (2pm-10pm): YesNo
Holidays: YesNo	3rd Shift (10pm-6am): YesNo

Full-TimePart-Time  

Workday:	From:	To:
Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:

Education: High-School DiplomaSome College2-Year Degree4-Year Degree  

Other Education and Technical Schooling
List:

Other Special Training, Certificates, Licenses and Skills(PC Software, Equipment/Machine Operation, Languages, etc.)
List:

Employment History (start with your most recent job)
If currently employed may we contact your current employer? YesNo  

	Company Name	Your Job	Last Pay Rate
	Address	City	State
	Zip Code	Phone #	Supervisor's Name
		From	To
	Dates Employed:
	Reason for Leaving: Resigned with noticeResigned without noticeTerminationOther
	If other explain:
	To the best of your knowledge, would this company re-hire you? YesNoN/A

	Company Name	Your Job	Last Pay Rate
	Address	City	State
	Zip Code	Phone #	Supervisor's Name
		From	To
	Dates Employed:
	Reason for Leaving: Resigned with noticeResigned without noticeTerminationOther
	If other explain:
	To the best of your knowledge, would this company re-hire you? YesNoN/A

PLEASE READ CAREFULLY
THIS IS NOT AN EMPLOYMENT AGREEMENT OR CONTRACT.
However, by submitting this form you are agreeing to the following:

I certify that the information I have provided on this employment application is true and correct, and that no attempt has been made to conceal pertinent information. I understand that if any information given by me in this application is proven to be false or misleading, I will not be eligible for employment. If accepted for employment, I understand that the use of illegal drugs is prohibited and that any offer of employment is contingent upon satisfactory results of any required drug test and background investigation.

Thank you for applying with Rally! Your application will remain active for 90 days and remain on file for 1 year. We will notify you if a position that matches your qualifications becomes available. Again, we appreciate your interest in Rally.