Employment

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(PLEASE PRINT AND
COMPLETELY ANSWER ALL QUESTIONS)
Reynolds Pest Management, Inc.and its Clients fully subscribe to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans With Disabilities Act, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a full and fair opportunity to be considered for employment. As Equal Opportunity Employers, we intend to comply fully with applicable federal and State employment laws and the information requested on this application will only be used for purposes consistent with those laws. Applications are only accepted for positions currently available and will only be considered for thirty (30) days from today’s date or until the position applied for is filled, whichever first occurs.
POSITION APPLIED FOR:
DATE:

PERSONAL DATA:   

Salary expectations:  Telephone Number
Last Name: First Name Middle Name
Street Address  City State/Zip Code
Are you at least 18 years old?
If not, state your age for child labor law purposes only
Are there any days, shifts or hours you will not work?
If yes, please explain:
Are you available for out of town work? Will you work overtime, if required?
When will you be able to start work? Have you taken any illegal drugs in the last 30 days?
How did you learn of our Company? If referral, who were you referred by?
Have you ever applied or worked at Reynolds Pest Management, Inc. before? Yes No
If yes, provide dates:
Are you legally authorized to work in the United States? Yes No
Will you now or in the future require sponsorship for employment visa status (e.g., H-1 B visa status)? Yes No
Note: The Federal Immigration and Reform and Control Act of 1986 requires that an INS Employment Eligibility Verification “Form 1-9″ be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation
establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.
Have you been convicted of a felony Yes No Date of Conviction: If yes, please explain on the Additional Comments page 1, including the penalty imposed.
Have you been convicted of misappropriation of funds, embezzlement, or similar for other dishonest conduct; or an offense involving the use of a weapon; for burglary, robbery, breaking and entering or theft; or physical assault or other violent crime? Yes No If yes, please explain on the additional comments page.
Have you ever been a defendant in a civil action for an intentional tort (intentional commission of a wrongful act)? Yes No If yes, include nature of the intentional tort and the disposition of the action in the Additional Comments Section.

 

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DRIVING RECORD:
(Answer only if driving is a requirement of the job for which you are applying.)
Do you have a valid drivers license? Yes No
State License No
Have you had any tickets?
If yes, please explain:
Has your license ever been suspended or revoked?
If yes, please explain:
Do you have any OUI or OWI convictions?‑ If yes, please state when you were convicted and explain:
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RESIDENCES: (Please provide your addresses of residence for the past seven years beginning with the most recent address. If you need more space, please use the Additional Comments section.)
Street Address City, State and Zip Code From To
Street Address City, State and Zip Code From To
Street Address City, State and Zip Code From To
Street Address City, State and Zip Code From To
Street Address City, State and Zip Code From To
Street Address City, State and Zip Code From To

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EDUCATION: (May or may not be considered depending on job applied for.)
Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:
Name, City and State ofEducational Institution Graduated? If no Degree, Credits earned Type of Degree Received or Expected Grade Point Overall GPA
Yes No Major Minor
High School
College or University
Technical/GED/Other
Licenses,
Certifications/Other
Company Name:
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EMPLOYMENT HISTORY:
(Please complete for all full‑time or part‑time employment
beginning with most recent employer.)

Company Name Tel #
Address Dates Employed From To
Name of Supervisor May we contact? Yes No Rate of Pay Start Last
State job titles and describe job duties Reason For Leaving
Company Name Tel #
Address Dates Employed From To
Name of Supervisor May we contact? Yes No Rate of Pay Start Last
State job titles and describe job duties Reason For Leaving
Company Name Tel #
Address Dates Employed From TO
Name of Supervisor May we contact? Yes No Rate of Pay Start Last
State job titles and describe job duties Reason For Leaving
Company Name Tel #
Address Dates Employed From To
Name of Supervisor  May we contact? Yes No Rate of Pay Start Last
State job titles and describe job duties Reason For Leaving
Company Name:
Please explain any gaps in your employment history:
Have you ever been discharged or forced to resign?
If yes, explain:
Did you receive any discipline in the last 12 months of active employment?
If yes, please explain:
Were you given a performance evaluation within the last 12 months of active employment?
If yes, what was the range of scores used and what was your score?
Have you signed any non‑compete or non-solicit agreement with any otheremployer that might restrict you from working for this company?
If so, please explain:

(you may be required to furnish a copy of the agreement)

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MILITARY: (complete only if you served in the military.)

Branch of Service:
Number of Years/Months of Service:
Rank at Discharge:
Date at Discharge:
Reason for leaving:
Describe any military skills, training or experience you believe are relevant to the job applied for:
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APPLICANT’S ACKNOWLEDGMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document will disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document will be cause for my dismissal at any time without prior notice.

I understand that, if employed, my employment is not for a specific term and may be terminated by me or my Employer(s) with or without notice or cause at any time. I further understand that no oral promise, Employer(s) policy, custom, business practice or other procedure (including the Personnel Handbook or any personnel manuals) constitute an employment contract or modification of the at-will employment relationship between me and the Employer(s).

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation; take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize Reynolds Pest Management, Inc. and its clients to release the results of background checks (if any) and my pre-employment drug/alcohol test (if any), any information on this application and any relevant information about me to each other and to other Reynolds Pest Management, Inc. clients for whom I have applied for employment, and release Reynolds Pest Management, Inc. and its clients from any and all claims related to the lawful release of this information.

I acknowledge that this application will remain active for 30 days from this date. If I have not heard from the Company at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still wish to be considered for employment.

Signature:
Date:
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Company Name:
ADDITIONAL COMMENTS