Application - Reynolds Contracting Virginia

Date

Date Format: MM slash DD slash YYYY

Desired Position

Name

First Middle Last

Address

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

Phone

Email

Are you over 18 years of age?*

Yes
No

DL Number

DL State

Are you a U.S. Citizen?

Yes
No

If no, are you legally eligible 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:

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?

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

Have 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?

Yes
No

If yes, please explain:

Education

High School Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate or earn a GED?

Yes
No

College Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate?

Yes
No

Major/Degree Earned:

Trade/ Vocational Name

School Location (City, State)

Dates (MM/YYYY - MM/YYYY)

Did you graduate?

Yes
No

Diploma/Certificate Earned:

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

May we contact this employer?

Yes
No

If no, please explain:

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

May we contact this employer?

Yes
No

If no, please explain:

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

May we contact this employer?

Yes
No

If no, please explain:

Company Name

Position Title

Start Date

End Date

Direct Supervisor Name

Phone

Reason for leaving

May we contact this employer?

Yes
No

If no, please explain:

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 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*