Application - Reynolds Contracting Virginia

Date

Date Format: MM slash DD slash YYYY

Desired Position

Name

First Middle Last

SSN

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

DOB

DL Number

DL State

Are you a U.S. Citizen?

Yes
No

If no, are you legally entitled to work in the United States?

Yes
No

Have you been convicted of a crime other than a traffic offense?

Yes
No

If yes, explain:

Have you ever served in the U.S. Armed Forces?

Yes
No

Branch of Service:

Highest Rank Achieved:

Did you receive an honorable discharge?

Yes
No

Discharge date:

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?

Yes
No

Do you consent to a pre-employment drug and alcohol screening?

Yes
No

Do you consent to a random periodic drug and alcohol screenings during employment?

Yes
No

Have you been terminated from a previous employer or been allowed to resign in lieu of termination because of safety rules violations or incidents?

Yes
No

If yes, please explain:

Education

High School Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate?

Yes
No

College Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate?

Yes
No

Trade/ Vocational Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate?

Yes
No

Are you First Aid certified?

Yes
No

First Aid Certification Expiration Date

First Aid Certified by:

Provide name of organization.

Are you CPR certified?

Yes
No

CPR Certification Expiration Date

CPR Certified by:

Provide name of organization.

Would you be willing to obtain First Aid and/or CPR certification training during employment?

First Aid
CPR
Both

Employment History

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

References (must list at least three)

Reference Name

Phone

Relationship

Years Known

Reference Name

Phone

Relationship

Years Known

Reference Name

Phone

Relationship

Years Known

Reference Name

Phone

Relationship

Years Known

Special Skill / Certifications / Training

Authorization

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that falsified or misleading statements of 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 authorize investigation of all statements contained herein, and the references and employers listed above to give you any and all information concerning my previous employment, and any pertinent information they may have, personal or otherwise, and release the Company from all liability for any damage that may result from utilization of such information.
I understand that a consumer credit report or criminal records shall be preformed prior to my employment. I understand that, in compliance with federal law, the Company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports.
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 the Company. However, I further understand that neither the Company's 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 the Company may terminate my employment at any time with or without notice or cause.

Signature*