Application for Employment
As an EQUAL OPPORTUNITY EMPLOYER, all applicants seeking employment with F. A. Richard & Associates, Inc. are considered without regard to their race, color, sex, age, religion, national origin, disability, or other protected status where otherwise qualified. This application will be considered active for 60 days, after which is must be renewed. It must be completed in its entirety, where applicable, to be considered. If you need assistance completing this application, please contact FARA's Human Resource department. Omissions or falsifications may result in ineligibility for employment or dismissal if subsequently employed.

*** Required Fields

First Name***		Date May 11, 2008
Last Name***
Address***
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State***	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip***
Phone***
Alternate Phone
Best Time to Contact
Email Address
Position Applied For***	Adjuster Trainee - Avondale, LA Adjuster Trainee - Jackson, MS Adjuster Trainee - Pascagoula, MS Administrative Assistant - Mandeville, LA Bill Processor - Mandeville, LA Mailroom Clerk - Mandeville, LA Medical Case Manager - Pascagoula, MS Phone Audit Clerical Support - Lafayette, LA Phone Auditor - Lafayette, LA Telephone Consultant - Lafayette, LA Worker's Comp Adjuster - Corpus Christi, TX
Desired Wage/Salary***	Under 19,999 20-24,999 25-29,999 30-34,999 35-39,999 40-44,999 45-49,999 50-54,999 55-59,999 60-64,999 65-69,999 70-74,999 75-79,999 80-Plus
How Did you Hear About Us***	Newspaper Internet Ad Website Employee Referral Other Referral
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