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    General Information

       
    *Job You are Applying For:
    *First Name:
    *Last Name:
    *Home Phone:
    Street Address:
     
    City:
    State:
    Zip:
    *Email:
    Legal Residence

    (if different):

     


    Work History

     

     

    Experience and Employment. Please start with current or last position. Minimum of 3 verifiable past employers required.

     

    Employer 1

     

    Employer Name:
    Address:
    City:
    State:
    Telephone Number:
    Immediate Supervisor:
    Dates: to
    Duties:
    Reason for leaving:

     

    Employer 2

     

    Employer Name:
    Address:
    City:
    State:
    Telephone Number:
    Immediate Supervisor:
    Dates: to
    Duties:
    Reason for leaving:

     

    Employer 3

     

    Employer Name:
    Address:
    City:
    State:
    Telephone Number:
    Immediate Supervisor:
    Dates: to
    Duties:
    Reason for leaving:

     


    Other References

      Please do not list family members or relatives.
     
    Name:
    Phone Number:
    Address:
     
     
       
    Name:
    Phone Number:
    Address:
     
     

    Do you have friends or relatives working for Reed & Reed? (If yes, please name)
     
    Name:
    Relationship:
    Name:
    Relationship:

     
      In case of Emergency, notify:
    Name:
    Relationship:
    Address:
     
    City:
    State:
    Phone Number:

     
      Were you refered by a current Reed & Reed employee? (If yes, name)
     

    If yes, name:

     



     
      How soon are you available to start work?
      Date:
     

     
      If hired, you would be asked to work Monday through Friday, from 7:00 a.m. to 4:30 p.m. Are you able to meet this schedule?
     
       

     
      If hired, would you be willing to travel to different job locations throughout the state?
     
       

     
      Do you have a valid drivers license that is current AND reliable transportation? If NO - how will you get to work on time every day?
     
       

     
      Current Licenses and Certifications held: (Ex: WD Certs, Electrical License, etc.)
     
       

     
      Are you a convicted felon?
     
       

     
      Do you have any special skills?
     
     

    Substance Abuse Screen

     

      I hereby consent to urine substance abuse testing for the purpose of detecting drugs of abuse. I acknowledge that my prosepective employer, Reed & Reed, Inc. will request this test and upon my request will provide me with a copy of their Substance Abuse Program Policy. I understand that Reed & Reed, Inc. will deny employment to any person whose substance abuse screen is positive.
     
       

     
     

    Voluntary Affirmative Action Info

     

     

    Instructions to Applicant:

    Reed & Reed, Inc., is an Equal Opportunity Affirmative Action Employer. The information solicited on this page is being compiled to comply with federal record-keeping regulations and EEO/Affirmative Action requirements. The information provided on this form is CONFIDENTIAL. This page will be removed from your application prior to review and will not be a part of your application for employment or personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA ON THIS PAGE WILL NOT AFFECT ANY EMPLOYMENT DECISION.

     
    Name:
    Date of Birth:

     
     

    Please check applicable answers

       
     


     
     

    Referral Source

       
     



      Name of Current Employee:
     
      Other Referral:  

     
     

    Check answers which apply to you:

       
     

     
     

    I agree that any false statement in this application shall be sufficient cause for rejection or dismissal and hereby grant permission to investigate any information included in this application.

    I hereby authorize Reed & Reed to check court records, drivers license records, and credentials in connection with my application for employment with this company. I hereby release Reed & Reed from any and all liability of any type in connection with the obtaining of this information.

       
      I understand that by submitting this application, I agree to the terms stated above.
       

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