EMPLOYMENT APPLICATION

REINS INTERNATIONAL is an equal opportunity employer, and we do not and will not discriminate on the
basis of race, religion, national origin, sex, age, disability, marital status, or status as disabled veteran or
Vietnam-era veteran. Information provided on this application will not be used for any discriminatory purpose.

Personal Information
Last Name First Middle Date of Application Social Security Number
You will be required to submit a social
security number if an offer of
employment is made to you.
Present Address

No. Street City State Zip Code

Permanent Address (if different from Present Address)

No. Street City State Zip Code

Telephone No. (Home) Telephone No. (Day) Other Phone

Is any additional information relative to change of name, use of an assumed name, or nickname necessary to allow a check on
your work and educational records?

No Yes If yes, please explain and provide other names used

Have you ever applied or worked for this Company previously?

No Yes
Do you have any friends or relatives working presently at this Company?

No Yes
If yes, please state name(s) and relationship
How were you referred to us? Advertisement Employment Agency:
Please note one and provide College Employee:
detail where requested. Other:
If hired, would you have reliable means of Are you at least 18 years old?
transportation to and from work? If under 18, hire is subject to verification that you are of minimum age.

No Yes No Yes
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live & work in the United States?
Verification of either citizenship or the right to work will be asked for on the first day of employment.

No Yes
Are you currently employed? If you are currently employed, may we contact your current employer?

No Yes No Yes

Please complete all parts of this application by printing in ink; All portions of this application
must be completed regardless of whether or not a resume is attached.
 Personal Information (cont.)
Are you able to perform the essential job functions of the job for which you are applying?
If no, describe the functions that cannot be performed.
No Yes
Have you ever been convicted of a felony or have you pled guilty to a felony, or have you
been released from prison following a felony conviction in the last seven years?
No Yes
If yes, state nature of the crime(s), when and where convicted and disposition of the case

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offence, the date of the offense, the surrounding circumstances and the
relevance of the offense to position(s) applied for may, however, be considered.

Employment Interest
Type of employment desired? If you are applying for a Are you available to work Are you available to work
temporary position, are there overtime, if necessary? on weekends?
Full Time specific days or hours that
Part Time you are available to work?
Temporary or holiday/summer No Yes No Yes
Are you willing and able to travel for If given a job offer what is your If hired, what date are you available for work?
business? minimum acceptable salary?

No Yes

Military Service
Were you in the Armed Highest rank reached? Service Date (From/To) Are you an Active National
Services? If yes, what branch Guard or Reserve?
Specialty?

No Yes No Yes

Education & Training

List High School, Colleges, Location Major Did you Degree/diploma Grade
Universities, Professional Subject graduate? received or credit Average
Schools, Correspondence, etc. hours
High School

College/University

Vocational/Business

Other

What foreign languages do you Do you type? Can you use a Personal Computer? If yes, Please
speak fluently: specify type of system (MAC, Windows, Japanese,
etc.)

Read?
No Yes

Speak? If yes, how many words per Please list the type of software you can use. Please list
minute? your level of proficiency (high, medium, low)

Write?

Please complete all parts of this application by printing in ink; All portions of this application
must be completed regardless of whether or not a resume is attached.
 Education & Training (cont’)
Do you have any other special skills or knowledge or training that will help you in qualifying for employment with us? Please
list.

Professional organizations and/or volunteer activities (You may exclude information that indicates religion, age, disability
status, race, or national origin)

Work Experience (List your last employer first)

Employer’s Name, Address, Supervisor’s Name & Title Your Title Dates Salary (provide Reason for
& Phone No. Employed hourly or monthly) Leaving
From To Start Finish

May we contact for references: Yes___ No___

May we contact for references: Yes___ No___

May we contact for references: Yes___ No___

May we contact for references: Yes___ No___

May we contact for references: Yes___ No___

Please complete all parts of this application by printing in ink; All portions of this application
must be completed regardless of whether or not a resume is attached.
 Professional References
Give the names, addresses and telephone numbers of three business/professional references we may contact at ths time (no
relatives)
Name Title/Company Address Phone Number

Certification & Acknowledgment

1. Truthful Application. I certify that all the information provided in this application is true, and that I have not knowingly
withheld any facts that might affect the company’s decision to employ me. I am aware that any misrepresentation or
omission on this application shall be sufficient cause for rejection of this application or for immediate termination of
employment if I am employed, regardless of the time elapsed before discovery.

2. Consent to employment verification. I hereby authorize REINS INTERNATIONAL to thoroughly investigate my

references, work record, education and other matters related to my suitability for employment, and further authorize
the references I have listed to disclose to REINS INTERNATIONAL any and all letters, reports, and other
information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby
release REINS INTERNATIONAL my former employers and all other persons, corporations, partnerships and
associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation
or disclosure.

3. New Hire Orientation Period. I understand all new employees are on a three-month new hire introductory period,
after which suitability for regular employment will be decided by the Company.

4. Employment-at-will relationship. I understand that nothing contained in the application, or conveyed during any
interview which may be granted or during my employment, if hired, is intended to create an employment contract
between me and Company. In addition, I understand and agree that if I am employed, my employment is for no
definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either
myself or the Company, and that no promises or representations contrary to the foregoing are binding on the
Company unless made in writing and signed by me and the Company’s President or equivalent position.

5. Proof of Legal Right to Work in U.S. I understand that if I am hired, I will be required to provide proof of identity and
proof that I may legally work within the U.S.

6. Background Checking. I understand that REINS INTERNATIONAL will perform a background check on all
applicants who receive employment offers. All checks will be performed by a third-party and will be completed at the
expense of the Company. I hereby certify that the entries made on this employment application are true and correct.
I agree to submit to a post-offer pre-employment substance and/or alcohol examination.

PLEASE READ THE ABOVE STATEMENTS AND SIGN TO INDICATE YOUR AGREEMENT

SIGNATURE DATE

Please complete all parts of this application by printing in ink; All portions of this application
must be completed regardless of whether or not a resume is attached.