Redlands Contracting LLC

First name (Primero)

Last name (Último)

SSN (Número de la seguridad social)

Current Address (Direccion Actual)

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Phone

Email

Date you can start

Position Applying for

Referred By

Pay Rate Desired

Are you 18 Years of Age?

Yes

No

Are you a citizen of the United States?

Yes

No

If not, are you authorized to work in the United States?

Yes

No

Have you ever worked for Redlands Contracting LLC?

Yes

No

Do you have any friends/relatives that work for Redlands Contracting LLC? If so, who?

Are you willing to travel within the state of Oklahoma?

Yes

No

Do you have reliable transportation?

Yes

No

Are you willing to work 40-60 hours per week on a regular basis? (May include weekends)

Yes

No

What languages do you speak fluently?

English

Spanish

Other

Have you ever been convicted of a felony?

Yes

No

If yes, please explain below.

Education

High School

City, State

Did you graduate?

Yes

No

College/Trade School/City, State

Did you graduate?

Yes

No

Experience

Laborer

Skilled

Unskilled

Truck Driver

Truck/Trailers

Concrete Mixer

Dump Truck

Clerical

MS Excel

MS Outlook

MS Word

MS Office

Please list other special training and/or skills related to the position to which you are applying:

References

Reference 1

Relationship

Phone

Company name

Reference #2

Relationship

Phone

Company name

Previous Employment

Company name

Phone

Address

Supervisior

Job Title

Dates of Employement

Job Duties

Reason for Leaving

May we contact previous employer?

Yes

No

Company name #2

Phone

Address

Supervisor

Job Title

Dates of Employment

Job Duties

Reason for Leaving

May we contact previous employer?

Yes

No

Voluntary Identity Self Disclosure

Redlands Contracting LLC are contractors subjected to the rules and regulations of U.S. Government Executive order 11246, as amended, which requires the company to employ, upgrade, transfer, promote, layoff, or terminate without regard to race, age, color, religion, sex, disability, or national origin. The U.S. Government requires Redlands Contracting LLC to maintain the information requested below for the purpose of determining the impact of Redlands Contracting LLC. employment procedures. This information will be kept confidential. It will be filed separately from your application form and if employed, separate from your personnel file. This information will only be used in accordance with prescribed federal regulations.

NOTE: The information requested in this form is completely voluntary and will be kept confidential. We will use the data you provide us for periodic government reporting purposes only. Also, this form will be stored separately from each employee’s personnel file. Refusal to provide this information will NOT subject you to any adverse treatment. However, your cooperation in this would be greatly appreciated.

First Name/Last Name

Date

Month

Day

Year

Position Applying for:

SSN

DOB

Month

Day

Year

Race

I authorize investigation on all statements contained in this application. I understand that mispresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may; regardless of the date of payment of my wages and salary, be terminated at any time without case and without any previous notice.

Date

Signature

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