Application For Employment
Equal Opportunity Employer
NOTE: None of the information requested will be used to discriminate against any individual for any reason prohibited by law.
Applications are kept on file for 1 year from date of submission.

Notice to Applicants:
If you become an employee of this company, you will be expected, by Company Safety Policy, to wear the authorized personal protective Safety Equipment, Hard Hats, Safety Glasses, Respirators, Etc. Failure to follow the Company Safety Rules or any other company rule or policy will result in disciplinary action up to and including termination of employment.

Please answer all questions. If question does not apply, mark "n/a"

PERSONAL
Position Desired: (i.e. dozer operator, truck driver, laborer)


How did you learn about this position?



Details (who/which one etc):


Name:


Have you ever used a name other than that shown above: (Nickname also) List name and dates used:


Have you ever used another social security number? List number and dates used:



Present Address:
Street:
City/State/Zip:

Telephone:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Are you available to work:
Are you currently employed?
May we contact your present employer?
Are you currently on "lay-off" status and subject to recall?
Have you ever been employed by us before? If yes, give date      Date:

Can you travel if the job requires it?      Out of Town?      Out of State?
Do you have reliable transportation to get yourself to and from the job site?

Do you currently have any charges pending against you or have you been charged or convicted of any charge other than a simple misdemeanor or traffic violation in the last 7 years?
Are you at least 18 years of age?
Do you speak, read or write fluently a language other than English?
If yes, describe ability and list language(s)
On what date would you be available for work?

What types and makes/models of construction equipment can you operate or repair?
Operate:
Repair:

EMPLOYMENT RECORD
INSTRUCTIONS TO APPLICANT:
1. List employment for at least last 10 years. All time must be accounted for (explain any gaps in employment).
2. If former employer out of business, furnish name & phone number or address of person who can verify your employment.
3. If self-employed, furnish name, phone number or address of a non-relative who can verify employment.

Is your current employer aware that you are seeking other employment?
Present or Most Recent Employer
Month and Year
Name:
From

To
Positions Held and Duties Performed
Street Address:
City, State, Zip:
Salary:
Starting:

Ending:
Reason for Leaving
Supervisor:
Telephone Number:

Previous Employer
Month and Year
Name:
From

To
Positions Held and Duties Performed
Street Address:
City, State, Zip:
Salary:
Starting:

Ending:
Reason for Leaving
Supervisor:
Telephone Number:

Previous Employer
Month and Year
Name:
From

To
Positions Held and Duties Performed
Street Address:
City, State, Zip:
Salary:
Starting:

Ending:
Reason for Leaving
Supervisor:
Telephone Number:

Previous Employer
Month and Year
Name:
From

To
Positions Held and Duties Performed
Street Address:
City, State, Zip:
Salary:
Starting:

Ending:
Reason for Leaving
Supervisor:
Telephone Number:

Previous Employer
Month and Year
Name:
From

To
Positions Held and Duties Performed
Street Address:
City, State, Zip:
Salary:
Starting:

Ending:
Reason for Leaving
Supervisor:
Telephone Number:


CERTIFIED DRIVER APPLICATION
The following information is necessary for us to request information concerning your driving record as required by Company policy.


Do you have a valid driver's license?      If yes, please indicate: State:
Do you have a valid CDL License?      If yes, please indicate class and any endorsements:
License Number:      Expiration Date:

Have you been involved in or charged with the following in the past five (5) years? If so, list number of involvements or charges.

Accidents involving motor vehicle? Number:
Major moving violations? Number:
Hit & run, leaving the scene of an accident? Number:
Driving under the influence of alcohol or drugs? Number:
Any felony, homicide or manslaughter involving use of motor vehicle? Number:
Racing or excessive speeds? (20 mph over limit) Number:
Reckless, negligent or careless driving? Number:
License suspension or revocation? Number:
Speeding? Number:
Other moving Violations? Number:

DRIVER RELEASE
In connection with any job offer for employment with Reilly Construction Co., Inc., I understand that information being requested may include information as to my character, work habits, performance and experience, along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information concerning my driving record and/or information from various federal, state, and other agencies including current and previous employer(s) which maintain records concerning traffic offenses, accidents, etc. concerning (1) previous driving record requests made by others from such state agencies; (2) state provided driving records; (3) claims involving me in the files of insurance companies.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY REILLY CONSTRUCTION CO., INC. TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have a right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

EDUCATION
Name and Location
Date
From
Date
To
Graduated
(Y or N)
Major Subject & Hrs. Completed
Minor Subject & Hrs. Completed
GPA\HRS
High School(s)
College
Tech., Etc.

REFERENCES
Not related to applicant
Name Phone City Zip
Name Phone City Zip
Name Phone City Zip

PRE-EMPLOYMENT PHYSICAL/TESTING NOTICE
REILLY CONSTRUCTION CO., INC. is committed to maintaining a drug-free workplace. Therefore, all candidates for employment (applicants to whom a contingent offer of employment has been made) are required to complete a medical examination, including testing for drug and alcohol use, by a physician of REILLY CONSTRUCTION CO., INC.'S choice. An offer of employment is contingent upon a candidate's submission to and successful completion of the medical exam and test.

APPLICANT'S ACKNOWLEDGEMENT
I agree to undergo the pre-employment physical and drug/alcohol test. I understand that the results of such a test will be disclosed only to REILLY CONSTRUCTION CO., INC., Human Resources personnel and others with a need to know, or as required by law. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide a false or tampered urine sample or fail to successfully complete the physical or drug/alcohol test, I will not be hired in accordance with REILLY CONSTRUCTION CO., INC.'S policy.

Permission is granted to REILLY CONSTRUCTION CO., INC. to conduct and investigation and to solicit information as to my educational and employment history, character and general reputation, driving record, and criminal conviction record. I release REILLY CONSTRUCTION CO., INC. and all persons and organizations from any liability arising from such statements, their solicitation or use.

I understand that this employment application and other company documents are not contracts of employment and that any individual who is hired may voluntarily leave or be terminated at any time, with or without cause. If terminated, I authorize REILLY CONSTRUCTION CO., INC. to deduct, to the extent permitted by law, any amount which I may owe to REILLY CONSTRUCTION CO., INC. from any amount which REILLY CONSTRUCTION CO., INC. may owe me. I understand that no manager, employee or other representative of REILLY CONSTRUCTION CO., INC. is authorized to offer employment to me or enter into an employment agreement with me for lifetime employment or for employment for a specified period of time. I further understand that no manager, employee or representative of REILLY CONSTRUCTION CO., INC. is authorized to delete or change any of the conditions, requirements or acknowledgement which are required to me as an applicant for employment or later, if hired, as an employee of REILLY CONSTRUCTION CO., INC.

I certify that all statements made by me on this application are true and correct to the best of my knowledge and belief. I understand that any false, inaccurate, or omitted statements of a fact could be cause for rejection of my application or termination of my employment at any time.

I have read, understand, and by submitting this form, do hereby consent to these statements.