Programs, services, and employment are available equally to everyone. Please inform the Human Resources Department if you require reasonable accommodation to the application or interview.

Fields marked * are required.

Date:

 
Application Data
How were you referred to us?
Position applied for? *
Last Name *
First Name *
Middle Name
Address *
City *
State *
Zip Code *
Phone *
Mobile, Beeper or Other Phone
Email
Date Available to Start
Salary Requirement
  
If you are under 18 years of age and we require a work permit, can you furnish one?


If no, please explain 
Have you ever worked for this company?
No
If yes, when?  
Are you a citizen of the United States?
No
If not, do you have work papers?
No
Type of employment desired
Have you ever been convicted of a felony or misdemeanor?
Yes No
If yes, 
give dates and details  

Answering yes to these questions does not constitute an automatic rejection to employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into consideration.

 
Education  
High School 
Address 
# of Years Completed
Did you Graduate?
Yes No
Degree
Major
GPA

College/University 
Address 
# of Years Completed
Did you Graduate?
Yes No
Degree
Major
GPA

Other 
Address 
# of Years Completed
Did you Graduate?
Yes No
Degree
Major
GPA
 
References  
Name *
Address *
City *
State *
Zip *
Phone *

Name
Address
City
State
Zip
Phone

Name
Address
City
State
Zip
Phone
 
Summarize Your Special Skills or Qualifications  
 
Previous Employment (begin with most recent position)  
Dates of Employment: From * 
To *
Position Held *
Firm *
Address *
Phone *
Supervisor *
Title *
Responsibilities
Starting Salary & Title *
Ending Salary
Reason for Leaving
May we contact this employer for reference?
Yes No

Dates of Employment: From 
To
Position Held
Firm
Address
Phone
Supervisor
Title
Responsibilities
Starting Salary & Title
Ending Salary
Reason for Leaving
May we contact this employer for reference?
Yes No

Dates of Employment: From 
To
Position Held
Firm
Address
Phone
Supervisor
Title
Responsibilities
Starting Salary & Title
Ending Salary
Reason for Leaving
May we contact this employer for reference?
Yes No


 
   

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's President, and then only when in writing and signed by the President, has any authority to enter into any agreement for employment for any specified of time, or to make any agreement contrary to the foregoing."

 
     
 
 
 

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Henry H. Ross & Son, Inc.
121 Koser Road
Lititz, PA 17543
Phone: (717) 626-6268
Fax: (717) 626-7211
E-mail: contact@hhross.com

Showroom Hours: Monday through Friday 8 a.m. to 5 p.m.
Other hours by appointment.

Map to Showroom

© Copyright 2004-2008 Henry H. Ross & Son, Inc. All Rights Reserved.