Personal Information

Full Name (First + Middle + Last)*

Present Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Email

Are you 18 years or older?*

Yes
No

Are you authorized to work in the U.S.?*

Yes
No

How did you find us?*

If referred by a Royalty employee, please provide the name

Employment Desired

Position

Date you can start

Desired Salary

Are you currently employed?*

Yes
No

Name of employer*

May we speak to your current employer?*

Yes
No

Employer contact name*

Employer contact phone number*

Have you ever been previously employed by Royalty Companies?*

Yes
No

If so, when and where?

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*

1
2
3
4

Diploma?*

Yes
No

GED?*

Yes
No

Name(s) and address(es) of institution(s)

College and/or vocational school: number of years completed*

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?*

Yes
No

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. Click the + button to add a new row.

From Month/Year To Month/Year	Name/Address of 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?

Yes
No

Please explain.

References

Give the names of 3 persons not related to you, whom you have known at least one year. Click the + button to add a new row.

Name	Address	Business	Years Acquainted

Would you like to add a resume (optional)?

Yes
No

Add resume

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

Yes
No

Add cover letter

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Paste cover letter here

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

This application will be considered to be valid one month from this 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:*

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

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

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

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On-line Employment Application - English

Personal Information

Employment Desired

Education, Licenses, Professional Memberships

Employment History

References

Applicant Statement

Drug Policy

Authorization for Verification of Driving Record