ATTENTION APPLICANT

ALL APPLICANTS CONSIDERED FOR HIRE WILL BE
SUBJECTED TO A BACKGROUND CHECK.
AND PRE-EMPLOYMENT DRUG TESTING

**Please read carefully and complete**

An Equal Opportunity Employer. We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose. PRI conforms to the Drug Free Workplace Act.

* Fields with red asterisks are required.

PRI APPLICANT AFFIRMATIVE ACTION SURVEY

You need not provide the information requested below in order to be considered for employment by PRI However, the information you provide will be used by PRI to help fulfill its reporting requirements to Federal and State Agencies. This information will not be made a part of your permanent personnel record.

*Name:
Date of Birth:	[mm/dd/yyyy] Sex: Select Male Female
Group Identity:	Select White not of Hispanic origin Black not of Hispanic origin Hispanic American Indian or Alaska Native Asian or Pacific Islander
Referral Source:	Select Advertisement Employment Agency Employee Relative Other

 

 

*Date of Application: [mm/dd/yyyy]
*Last Name:		* First Name:		MI:
Drivers License Number		Drivers License Expiration Date		Type Work Desired
* Street Address
* City		* State		* ZIP

* Home Phone w/area
Cell Phone
Date of Birth (Required only for commercial drivers):