Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are an equal opportunity employer. Applicant and employee screening tests for alcohol and illegal drug use are required before placement and during employment. The field descriptions in RED text are required and must be filled out correctly otherwise application will not submit! You must have a valid e-mail address to submit this application. Personal Information
First Name:		Middle Name:
Last Name:		Social Security Number:
Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:		Phone (Format: ###-###-####):
Other Phone (Format: ###-###-####):		E-mail Address:
Best Time to Call Home:
Driver's License Number :		State Issued:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
License Classification:
Division for Employment:	Select... Pennsylvania Virginia
Desired Position:	Select... Clerical Driver with CDL A Driver with CDL B Foreman Laborer Operator Other To view a list of job descriptions please click here.
Desired Salary:
Referral Source:	Select... Advertisement Employee Agency Job Fair Walk-in Relative Internet School Government Other	Name of Source
Are you legally authorized to work in the U.S.?: (If hired, you will be required to provide proof of work authorization.)		Yes No
Will you travel if job requires it?:		Yes No
Will you work overtime if required?:		Yes No
If no, please explain:
Have you ever been convicted of a crime (felony)?:		Yes No
If yes, give date(s) and details: (Convictions are not automatic bar to employment)
Are you presently employed?:		Yes No
If so, may we contact your present employer (required for CDL Drivers)?:		Yes No
May we contact you at work?:		Yes No
If so, best time to call you at work?:
Work phone number:
If hired, when would you be available?:
Employment History
Please list chronologically, beginning with most recent experience.
Employer:		May we contact as a reference (required for CDL Drivers):	Yes No
Address:		City/State/Zip:
Supervisor:		Phone:
From (MM/YYYY):		To (MM/YYYY):
Start Job Title:		Final Job Title:
Start Salary:		Final Salary:
Type of Work:
Reason for Leaving:
Employer:		May we contact as a reference (required for CDL Drivers):	Yes No
Address:		City/State/Zip:
Supervisor:		Phone:
From (MM/YYYY):		To (MM/YYYY):
Start Job Title:		Final Job Title:
Start Salary:		Final Salary:
Type of Work:
Reason for Leaving:
Employer:		May we contact as a reference (required for CDL Drivers):	Yes No
Address:		City/State/Zip:
Supervisor:		Phone:
From (MM/YYYY):		To (MM/YYYY):
Start Job Title:		Final Job Title:
Start Salary:		Final Salary:
Type of Work:
Reason for Leaving:
Explain Gaps in Employment:
Educational Background
Name & Location of School Enter Last Year Completed Major Course Diploma/Degree GPA/Class Rank
Skills and Qualifications
Summarize any special training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying:
Computer Skills (Check all that apply):	Word Processing Spreadsheet Presentation E-mail Internet Other
Have you ever been bonded (Clerical Positions Only) :	Yes No
Employment References
List individuals familiar with your job qualifications (No relatives or personal friends).
Name of Reference:		Occupation:
Address:		City/State/Zip:
Phone:		Relationship:
How long known:
Name of Reference:		Occupation:
Address:		City/State/Zip:
Phone:		Relationship:
How long known:
Name of Reference:		Occupation:
Address:		City/State/Zip:
Phone:		Relationship:
How long known:

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete, and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organization for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

I understand that REH Holdings, Inc. and/or its subsidiaries will conduct a background check which will include a review of public records obtained from the Department of Motor Vehicles and a review of the applicant's criminal history in compliance with all applicable Federal and State laws.

I hereby authorize REH Holdings, Inc. and/or its subsidiaries to conduct this background check as part of my application process. If employed and I operate a Company owned or leased vehicle, I authorize the Company to review Department of Motor Vehicles records as deemed necessary by the company.

I release from liability REH Holdings, Inc., its subsidiaries and its representatives from seeking, gathering and using such information.

Check this box to certify that you have read and accept the above statement.