Date Date Format: MM slash DD slash YYYY Desired PositionName First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Are you over 18 years of age?*YesNoDL NumberDL StateAre you a U.S. Citizen?YesNoIf no, are you legally eligible to work in the United States?YesNoHave you been convicted of a crime other than a traffic offense?YesNoIf yes, explain:A conviction will not necessarily automatically disqualify you from employment. Rather, such factors such as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered. You do not need to report a conviction of simple marijuana possession.Have you ever served in the U.S. Armed Forces?YesNoBranch of Service:Highest Rank Achieved:Did you receive an honorable discharge?YesNoDischarge date: Date Format: MM slash DD slash YYYY Military Occupational Specialty:Awards / Commendations:Reynolds Contracting is a smoke free workplace. Smoking is not permitted on any company site, in any vehicle or any equipment. If hired, do you agree to adhere to this policy?YesNoHave you been terminated from a previous employer or been allowed to resign in lieu of termination because of violations of safety rules or incidents involving safety rules?YesNoIf yes, please explain:EducationHigh School NameSchool Location (City, State)Dates (MM/YYYY - MM/YYYY)Did you graduate or earn a GED?YesNoCollege NameSchool Location (City, State)Dates (MM/YYYY - MM/YYYY)Did you graduate?YesNoMajor/Degree Earned:Trade/ Vocational NameSchool Location (City, State)Dates (MM/YYYY - MM/YYYY)Did you graduate?YesNoDiploma/Certificate Earned:Are you First Aid certified?YesNoFirst Aid Certification Expiration Date Date Format: MM slash DD slash YYYY First Aid Certified by:Provide name of organization.Are you CPR certified?YesNoCPR Certification Expiration Date Date Format: MM slash DD slash YYYY CPR Certified by:Provide name of organization.Would you be willing to obtain First Aid and/or CPR certification training during employment?First AidCPRBothEmployment HistoryCompany NamePosition TitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Direct Supervisor NamePhoneReason for leavingMay we contact this employer?YesNoIf no, please explain:Company NamePosition TitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Direct Supervisor NamePhoneReason for leavingMay we contact this employer?YesNoIf no, please explain:Company NamePosition TitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Direct Supervisor NamePhoneReason for leavingMay we contact this employer?YesNoIf no, please explain:Company NamePosition TitleStart Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY Direct Supervisor NamePhoneReason for leavingMay we contact this employer?YesNoIf no, please explain:References (must list at least three)Reference NamePhoneRelationshipYears KnownReference NamePhoneRelationshipYears KnownReference NamePhoneRelationshipYears KnownReference NamePhoneRelationshipYears KnownSpecial Skill / Certifications / TrainingAuthorizationI certify that the information contained in this application is true and complete to the best of my knowledge and authorize Reynolds Contracting to verify their accuracy and to obtain reference information on my work performance. I hereby release Reynolds contracting from any/all liability of whatever kind and nature which, at any time, could result from obtaining and basin an employment decision on such information. I understand that falsified or misleading statements or any kind or omissions of information called for on this application may result in disqualification for consideration for employment or, if already employed, grounds for immediate dismissal. I understand this application for employment is valid for 90 days only. Consideration for employment after 60 days requires a new application. I understand that should an employment offer be extended to me and accepted, I will fully adhere to the policies and practices of employment of Reynolds Contracting. However, I further understand that neither the policies or practices or anything said during the interview process shall be deemed to constitute the terms of an express or implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or Reynolds Contracting may terminate my employment at any time with or without notice or cause.Signature* REYNOLDS CONTRACTING, LLC IS AN EQUAL OPPORTUNITY EMPLOYER.