[FrontPage Save Results Component]
Online Application
General Information
Position Applied For:

Full Time

Part Time

Temporary
If Part Time, state days and hours available
Date Available
Personal Information
First

Middle

Last

Address
Address
City

State

ZIP
Home Phone Work Phone
Social Security Email Address
College Degree
Work Experience -- Last 3 (three) positions, listing most current first.
Current or Most Recent
Date From Date To
Job Title Name of Supervisor
Responsibilities
Name of Employer
Address
Address
City State ZIP
Reason for Leaving
May we contact your present employer? Yes No
Second Most Recent
Date From Date To
Job Title Name of Supervisor
Responsibilities
Name of Employer
Address
Address
City State ZIP
Reason for Leaving
Third Most Recent
Date From Date To
Job Title Name of Supervisor
Responsibilities
Name of Employer
Address
Address
City State ZIP
Reason for Leaving
Other
If hired, can you furnish proof that you are at least 18 years of age? Yes No
If hired, can you furnish proof that you are authorized to work in the U.S.? Yes No
Have you ever been convicted of a felony? (A yes answer does not automatically disqualify you from employment.) Yes No
If yes, please explain.
Have you ever been convicted, pleaded guilty, or pleaded "no contest" to any criminal offense involving dishonesty or a breach of trust?  (A yes answer does not automatically disqualify you from employment.) Yes No
If yes, please explain.
Are you bondable? Yes No
If no, please explain.
Do you have any commitments to another employer that might affect your employment with our firm? Yes No
If yes, please explain.
Have you ever worked under a different name, or is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work or school record? * Yes No
If yes, give name, name of school and/of company, and dates.

* This firm is an equal employment opportunity employer dedicated to a policy of nondiscrimination upon any basis, including race, color, creed, religion, age, sex, national origin, ancestry, sexual orientation, marital status, military status, or the presence of any non-job-related medical condition or handicap.   In reading and answering the questions in this application, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences, or discrimination based upon any non-job-related information.

blank.gif (49 bytes)
Rotenberg & Co. LLP
Certified Public Accountants & BusinessConsultants
email to: career@rotenbergllp.com
 


1870 Winton Road South
Rochester, NY 14618
Phone: 585 295-2400
Fax: 585 295-2150