NOTE TO CANDIDATE: The following information is needed to help make the best possible employment selection. All portions of this application pertaining to you must be completed. Ray’s Flooring is committed to a policy of providing equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, age, gender, religion, national origin, marital status, physical or veteran status, disability, genetic information, gender identity, or any other characteristic protected by law. If accommodation is required, it is the responsibility of the candidate to inform the Human Resources Representative. Based upon contractual requirements, employees may be required to submit to and pass a drug test as a conditional offer of employment.

Ray's Flooring Application

Ray's Flooring Job Application Form

Name*
First Middle Last
Today's date:*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Are you over the age of 21?*
- Yes
- No
What position are you applying for?*
When are you available to start?*
MM slash DD slash YYYY
What type of employment are you interested in?
- Full-time employment
- Part-type employment
- Other
If you selected "Other Employment", please explain:
Are you willing to work:
- additional hours, if needed.
- weekends, if needed.
Select all that apply.
What days and/or hours are you UNABLE to work?
Are you a former Ray's Flooring employee?*
- Yes
- No
If you were a former Ray's employee, please provide dates:
Are you legally eligible for employment in the U.S. without sponsorship?*
- Yes
- No
Proof of identity & eligibility will be required upon employment.
If you were referred to us, please provide the following:
Referrals name
First Last
Relationship to you:
What is their relationship to you?
Do you have any relatives working here?
If yes:
What is their name?
First Last
Certifications, Licenses, and Endorsements
Certificates, Endorsements, or Licenses (Explain Type)
Explain Type: State of Issue Issued/Award Date Expiration Date

Include expiration date, etc. Verification will be completed based upon the information provided.
Education
High School
Name Addresss GPA Did you graduate? Yes/No
Associates Degree, Trade/Vocational
Name Address GPA Course of Study (provide major) Did you graduate? Yes/No Degree (do not provide year)
Undergraduate
Name Address GPA Course of Study (provide major) Did you graduate? Yes/No Degree (do not provide year)
Undergraduate School
Name Address GPA Course of Study (provide major) Did you graduate? Yes/No Degree (do not provide year)
Employment History
Provide at least 5 years and start with current/recent positions. Please provide accurate and complete employment history. If you attach a resume, please do not indicate "See Resume".
Have you encountered gaps in your employment history THAT ARE NOT due to personal illness, injury, or disability?*
- Yes
- No
If there are any gaps in your employment history, please explain:
1)
Employer*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Dates of employment:*
Start Date: mm/yy End Date: mm/yy
Title/Position*
Beginning Title Ending Title
Name and Title of your Supervisor:*
Name Title
Description of your duties:*
Reason for leaving:
May we contact employer listed above?*
- Yes
- No
Have you been asked to resign or involuntarily been terminated from this job?*
- Yes
- No
If you have asked to resign or involuntarily quit, please Explain:*
2)
Employer*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Dates of employment:*
Start Date: mm/yy End Date: mm/yy
Title/Position*
Beginning Title Ending Title
Name and Title of your Supervisor:*
Name Title
Description of your duties:*
Reason for leaving:
May we contact employer listed above?*
- Yes
- No
3)
Employer*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Dates of employment:*
Start Date: mm/yy End Date: mm/yy
Title/Position*
Beginning Title Ending Title
Name and Title of your Supervisor:*
Name Title
Description of your duties:*
Reason for leaving:*
May we contact employer listed above?*
- Yes
- No
4)
Employer
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Dates of employment:
Start Date: mm/yy End Date: mm/yy
Title/Position
Beginning Title Ending Title
Name and Title of your Supervisor:
Name Title
Description of your duties:
Reason for leaving:
May we contact employer listed above?
- Yes
- No
5)
Employer
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Dates of employment:
Start Date: mm/yy End Date: mm/yy
Title/Position
Beginning Title Ending Title
Name and Title of your Supervisor:
Name Title
Description of your duties:
Reason for leaving:
May we contact employer listed above?
- Yes
- No
Driving Records
COMPLETE FOR DRIVING POSITIONS ONLY.
Do you have a valid unexpired driver's license:
- Yes
- no
Specify State of Issue:
Do you have access to a vehicle to use for business purposes, if applicable to the position?
- Yes
- No
Is there any reason that you would not be approved as a driver when a motor vehicle record report is run?
- Yes
- No
If you would NOT BE APPROVED as a driver, please explain:
If your position is an installer, do you understand that you will report to various work sites to perform your work and that the time worked IS NOT PAID until you arrive at the work site and began work?
- Yes
- No
Foreign Language
An assessment may be completed prior to hiring.
List
Language Proficient in Reading Proficient in Speaking Proficient in Writing

F = Fluent, C = Conversationalist, N/A = Not Available
Professional References
List THREE professional references who have knowledge of your professional experiences. Only list people you want to be contacted. All information below is required. PLEASE DO NOT LIST RELATIVES, FRIENDS OR RAY'S FLOORING EMPLOYEES.
References (An assessment may be completed prior to hire.)*
Name Phone or Email Occupation / Business Relationship How Long Known
CONDITIONS OF APPLICATION
APPLICANT ACKNOWLEDGEMENT OF TERMS AND CONDITIONS OF APPLICATION*
In exchange for Ray’s Flooring Inc. (a.k.a. Ray’s Flooring) consideration of this employment application:
I certify that all information I have supplied in this application and any other form, oral or written is true and accurate, and I agree that any misstated, misleading, incomplete or false information is grounds for rejection of this application, refusal to hire or immediate discharge without recourse.
I understand and agree that Ray’s Flooring, any agent acting on their behalf, as well as any other person responding to reference request pursuant to this application, can and will seek and/or disclose any and all information about me which Ray’s Flooring, agent or agents, or persons may have. I specifically authorize said disclosure and agree to hold all such corporations, agents, or persons harmless for the same. That is, I will not file a lawsuit, claim or charge against them for such disclosure. Nor will I threaten same or otherwise seek any kind of compensation for such disclosure.
I understand and agree with the fact that Ray’s Flooring maintains a drug-free workplace, that maintenance of it is essentially for the safety of the workplace and employees, and that I may be required to undergo drug and/or alcohol impairment screening and testing. I also understand and agree that I may be subject to such testing during the course of my employment. I understand that, subject to applicable law, Ray’s Flooring shall be the sole judge of the acceptability of any tests results. I also acknowledge that I have been advised that Ray’s Flooring is an Equal Opportunity Employer and that Ray’s Flooring administers its employment policies in a nondiscriminatory manner.
I specifically authorize Ray’s Flooring to investigate my background, including any and all references, available criminal and other judicial records, and my credit record, consistent with applicable law. I understand that Ray’s Flooring will notify me if and when a credit record investigation is performed, and the sources investigated. I authorize Ray’s Flooring to use all legal means at its disposal to assess my suitability for employment. I make this authorization in return for Ray’s Flooring consideration of me for employment, and I specifically release and hold Ray’s Flooring harmless for any and all liabilities arising out of their investigation of my application for employment.
I understand and agree that, if hired, my employment will be at-will, and that I or Ray’s Flooring can terminate this employment relationship at any time, with or without notice or cause, for any reason not prohibited by law.

I hereby certify that I have read and understand the Terms and Conditions of this Application for Employment.
Applicants Signature*
First Last
Date*
MM slash DD slash YYYY
Upload your resume, certificates, and/or any file you would like to include.
Accepted file types: jpg, pdf, docx, pages, Max. file size: 32 MB.

Machine-readable Files

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

https://www.cigna.com/legal/compliance/machine-readable-files

Application

Ray's Flooring Application

If you were referred to us, please provide the following:

Do you have any relatives working here?

Certifications, Licenses, and Endorsements

Education

Employment History

1)

2)

3)

4)

5)

Driving Records

Foreign Language

Professional References

CONDITIONS OF APPLICATION

Machine-readable Files

Our Mission

Location

Connect With Us

Name	Address	GPA	Course of Study (provide major)	Did you graduate? Yes/No	Degree (do not provide year)

Language	Proficient in Reading	Proficient in Speaking	Proficient in Writing

Name	Phone or Email	Occupation / Business	Relationship	How Long Known

Explain Type:	State of Issue	Issued/Award Date	Expiration Date

Start Date: mm/yy	End Date: mm/yy

Beginning Title	Ending Title

Name	Title