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Personal Information

First Name Last Name Middle

Address Number Street

City State Zip

Contact Phone Email

Were you ever employed by us? Yes No If yes, when?

How did you find out about us?

Newspaper Ad Russell Web site Friend Other Web site Professional Association Russell Employee Other

Education

School	Name	Address	Years Completed	Degree & Major

High School

College or University

Graduate School

Business/ Trade School

Miscellaneous

Have you ever been convicted of a crime? Yes No

If Yes, please provide nature of the offense, date, state and disposition:

Are you legally eligible to be employed in the United States? Yes No

(Proof of identity and eligibility will be required upon employment)

Are you a veteran of the U.S. Armed Forces? Yes No

Dates of military service Branch

Background

Skills / Abilities
Please list skills, specialized training, apprenticeships, or abilities relevant to the job for which you are applying:

Equipment / Computer Software
Please list equipment and computer software you can operate:

References
Please list two references other than relatives or previous employers.

Name		Name

Position		Position

Company		Company

Address		Address

Address 2		Address2

Phone		Phone

Work Experience

Name of Employer / Company

Address Number Street

City State Zip

Phone Supervisor Name

Your Job Title

Dates of Employment
From To

Reason for Leaving

Ending Salary

Name of Employer / Company

Address Number Street

City State Zip

Phone Supervisor Name

Your Job Title

Dates of Employment
From To

Reason for Leaving

Ending Salary

Name of Employer / Company

Address Number Street

City State Zip

Phone Supervisor Name

Your Job Title

Dates of Employment
From To

Reason for Leaving

Ending Salary

Resume

Attach a Word Document

Certification

I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatement of fact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or company policies. I further understand that an incomplete application or an absence of my typed name below on this application is just cause for rejection of this application. All statements made on this application, including employment information, are subject to verification as a condition of employment.

Type Full Name Date

My transmission of this application containing my "electronic signature" typed above shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Russell Construction Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.

Russell Construction Company complies with applicable state and local laws governing non-discrimination in employment in every location in which the companies has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.