Personal Information
Full Name (First + Middle + Last)

Present Address*

Address Line 2
State
ALAKAZARCACOCTDEFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
City

ZIP Code

Home Phone

Cell Phone

Email

Are you 18 years or older?
YesNo
Are you authorized to work in the U.S.?
YesNo
How did you find us?
Internet SearchNewspaper AdRadio AdHelp Wanted SignIndeed.comOther Online Job Board (e.g., Monster)FacebookReferred by a FriendReferred by a Royalty EmployeeOther
Employment Desired
Position

Date you can start

Are you currently employed?
YesNo
Have you ever been previously employed by Royalty Companies?
YesNo
Education, Licenses, Professional Memberships
Please indicate education and / or training that you believe qualifies you for the position you are seeking.
High School: number of years completed*
1234
Diploma?
YesNo
Name(s) and address(es) of institution(s)

College and/or vocational school: number of years completed
1234Beyond
Name(s) and address(es) of institution(s)

Major(s) / degree(s) earned

Other training / degrees
Please list other courses, degrees and / or certifications earned.

Professional Licenses or Memberships
Please list type(s) of license(s) held and / or other professional membership(s). Note: You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.

Have you ever been convicted of a felony?
YesNo
If the answer is “Yes,” please explain in concise detail in the space below, giving the dates and nature of the offense, the name and location of the court and the disposition of the case. A conviction may not disqualify you, but a false statement will.

Employment History
Please list your 3 most recent employers.
Job #1
Month/Year To Month/Year

Employer

Salary Position

Reason for Leaving

Job #2
Month/Year To Month/Year

Employer

Salary Position

Reason for Leaving

Job #3
Month/Year To Month/Year

Employer

Salary Position

Reason for Leaving

Please explain any gaps in your work history.

Have you ever been discharged or asked to resign from a job?
YesNo
Give the names of 3 persons not related to you, whom you have known at least one year.
Reference #1
Name

Address

Business

Years Acquainted

Reference #2
Name

Address

Business

Years Acquainted

Reference #3
Name

Address

Business

Years Acquainted

Would you like to add a resume (optional)?

Would you like to add a cover letter (optional)?

Applicant Statement
I understand and agree to the following statements:
This application is not a contract of employment.
Should Royalty Companies of Indiana, Inc. hire me and should any of the information that I have given in this application be found false, misleading, or incomplete, I shall be subject to dismissal.
I understand that Royalty Companies of Indiana, Inc. follows an “at will” policy of employment, meaning that I or Royalty Companies of Indiana, Inc. may terminate my employment at any time for any reason consistent with applicable law. My employment and compensation can be terminated with, or without cause, and with or without notice, at anytime, at the option of Royalty Companies of Indiana, Inc. and or myself.
I authorize investigation of all statements given on this application. Royalty Companies of Indiana, Inc. may contact any educational institution, law enforcement agencies, references, or employers listed on this application, except my current employer if so noted, and all other sources deemed necessary to verify/ investigate all information contained in the application. I hereby release all involved parties from any liability arising from such an investigation.
I declare that all the information given in this application is complete and true, which, if found false, will constitute significant grounds for refusal of hire or termination of my employment.
Applicant statement acknowledged and agreed to:*

Typing your First Name + Middle Initial + Last Name will act as your digital signature.
Date

Drug Policy
Royalty Companies of Indiana, Inc. believes that a workplace should be an environment that is safe and drug free for our employees. With this in mind, Royalty has a drug testing policy for employees that includes random testing. Royalty also prohibits possession or use of alcohol, drugs and or drug paraphernalia on company property.
To maintain and enforce this policy, Royalty Companies of Indiana, Inc. will adhere to the following policies:
*** All employees may be required to submit to post accident and random screenings.
*** If the Company has reason to believe that there has been a violation of this policy, the Company may inspect the employee, employees possessions and or vehicle on company property.
I have read, understood and agreed that not adhering to, and or observing the above policies, procedures, guidelines may lead to: corrective actions, probation and or immediate termination of my employment with Royalty Companies of Indiana, Inc.
Drug policy acknowledged and agreed to:

Date

Authorization for Verification of Driving Record
Upload an image of your driver's license here, or provide the license number and state in the fields below.

Driver's License Number

Driver's License State
—Please choose an option—ALAKAZARCACOCTDEFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
I hereby agree and authorize Royalty Companies of Indiana, Inc. to verify my driving record with the Bureau of Motor Vehicles*

Typing your First Name + Middle Initial + Last Name will act as your digital signature.
Date