1. technology and computing
2. consumer electronics
3. telephones
4. mobile phones

EMPLOYMENT APPLICATION
[ ] L.A
[ ] Culver City
[ ] Corporate
Name of position(s) applied for: __________________________________________________________
Type of Employment desired: [ ] Full Time [ ] Part Time
[ ] Temporary
Name: First: _________________ Last:____________________ Middle: ________________________
Other Names used:________________________________________________________________
Address: Street:__________________________________________________________________________
City:_________________ State:__________________ Zip:__________________
Telephone:_________________ SSN: _______-______-________ Driver’s License No:____________
- Are you at least 18 years of age?
YES / NO
- Are you legally eligible for employment in the United States?
YES / NO
(Proof of citizenship or immigration status will be required upon hire)
- Have you been employed by Rolling Greens or a related company before? YES / NO
- Have you ever been convicted of a felony or misdemeanor?
YES / NO
- Have you had such charges brough against you that were later reduced,
dismissed, or not adjusticated due to pre-trial intervention?
YES / NO
YES answers may be relevant of job related, but do not necessarily ban you from employment.
Marijuana offenses more than 2 years old need not be listed. If YES, please give dates and explain:
EMPLOYMENT HISTORY // Please list your last three employers beginning with the most recent
(include military experiences)
Employer: _____________________________________
May we contact them? YES / NO
Address: ___________________________________ Phone: _________________________
Employed From: _______________ Employed Until:____________ Hourly Rate: ______
Job Title: ______________________ Supervisor Name/Title: _______________________
Job Description _____________________________________________________________
Reason for Leaving: _________________________________________________________
Employer: _____________________________________
May we contact them? YES / NO
Address: ___________________________________ Phone: _________________________
Employed From: _______________ Employed Until:____________ Hourly Rate: ______
Job Title: ______________________ Supervisor Name/Title: _______________________
Job Description _____________________________________________________________
Reason for Leaving: _________________________________________________________
Employer: _____________________________________
May we contact them? YES / NO
Address: ___________________________________ Phone: _________________________
Employed From: _______________ Employed Until:____________ Hourly Rate: ______
Job Title: ______________________ Supervisor Name/Title: _______________________
Job Description _____________________________________________________________
CULVER CITY
LOS ANGELES
AN AHEIM
9528 Jefferson Blvd.
Culver City, CA. 90232
T: 310.559.8656
F: 310.559.0864
7505 Beverly Blvd.
Los Angeles, CA. 90036
T: 323.934.4500
F: 323.934.4544
1547 S. State College Blvd.
Anaheim, CA 92806
T: 714.558.6100
F: 714.558.6175
Reason for Leaving: _________________________________________________________
EDUCATION
School name & Location: _____________________________________________________________
Course of Study: _______________________________________
Graduated? YES / NO Degree: ___________________________________
School name & Location: _____________________________________________________________
Course of Study: _______________________________________
Graduated? YES / NO Degree: ___________________________________
REFERENCES
______________________
Name:
_______________
Phone:
_______________________
Relationship:
__________________
Years Known:
______________________
Name:
_______________
Phone:
_______________________
Relationship:
__________________
Years Known:
I hereby authorize you, at this time of my application for employment, or during the course
of my employment, to obtain information from any source as to my education, experience,
competence, character or medical history, as relates to the position for which I applied or in
which I may be employed unless otherwise stated. I certify that the information contained in
this application is true, complete, and correct to the best of my knowledge and belief. I
understand that any falsification or omission of information may cause my immediate
dismissal or rejection of this application. I agree that all statements made in this application
may be investigated. I also understand that I may be required to successfully complete a
medical examination, to include drug screening, for initial and continued employment. I
further understand that in the event that I am employed, such employment is at will. Neither
I, nor the employer, have agreed on any specific period of employment nor any specific
pay or benefits unless otherwise set forth on a separate contract. I further agree that I will
abide by all the rules, regulations, and policies of Rolling Greens of companies represented
by Rolling Greens and that failure to do so may result in termination.
____________________________________________
Signature:
________________
Date:
CULVER CITY
LOS ANGELES
AN AHEIM
9528 Jefferson Blvd.
Culver City, CA. 90232
T: 310.559.8656
F: 310.559.0864
7505 Beverly Blvd.
Los Angeles, CA. 90036
T: 323.934.4500
F: 323.934.4544
1547 S. State College Blvd.
Anaheim, CA 92806
T: 714.558.6100
F: 714.558.6175