Application for Employment

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

Position & Contact InfoStep 1 of 5

Instructions to Applicant

List employment for at least last 10 years. All time must be accounted for (explain any gaps in employment).
If former employer out of business, furnish name & phone number or address of person who can verify your employment.
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/Most Recent Employer

Company Name *

Supervisor *

Street Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone *

Employed From - To *

Month/Year

Salary Starting - Ending *

Month/Year

Positions Held and Duties Performed *

Reason for Leaving *

Previous Employer

Company Name

Supervisor

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Employed From - To

Month/Year

Salary Starting - Ending

Positions Held and Duties Performed

Reason for Leaving

Previous Employer

Company Name

Supervisor

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Employed From - To

Month/Year

Salary Starting - Ending

Positions Held and Duties Performed

Reason for Leaving

Previous Employer

Company Name

Supervisor

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Employed From - To

Month/Year

Salary Starting - Ending

Positions Held and Duties Performed

Reason for Leaving

Previous Employer

Company Name

Supervisor

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Employed From - To

Month/Year

Salary Starting - Ending

Positions Held and Duties Performed

Reason for Leaving

References

Not related to applicant

Name *

Phone *

City *

Zipcode *

Name *

Phone *

City *

Zipcode *

Name *

Phone *

City *

Zipcode *

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.

Applicant's Acknowledgment *

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

Message

Position Information

Personal Information

Instructions to Applicant

Present/Most Recent Employer

Previous Employer

Previous Employer

Previous Employer

Previous Employer

Certified Driver Application

Have you been involved in or charged with the following in the past five (5) years?

Driver Release

High School(s)

College

Tech, etc.

References

Pre-Employment Physical/Testing Notice

Applicant's Acknowledgement