Employment Application

Join Our Team!

Date

Position Applying for:(Required)

Name

First Last

If known by another name, list here

Date of Birth

Cell Phone

Home Phone

Starting with your current address, please list your address history for the last (3) years(Required)

Street

City, State & Zip

How Long?

Employment Type(Required)

Preferred Start Date(Required)

Expected Salary/Hourly Rate(Required)

Have you ever applied with us before?(Required)

If so, when?

Why do you wish to change positions?(Required)

How were you referred to us ?(Required)

Are you legally authorized to work in the United States?

This employer participates in the E-Verify program. If hired, verification will be required consistent with federal law.

Yes

Present / Previous Employer

Start Date

End Date

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor & Position(Required)

Your Position/Title(Required)

Your Duties(Required)

May we contact this Employer?(Required)

Yes

Present / Previous Employer

Start Date

End Date

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor & Position(Required)

Your Position/Title(Required)

Your Duties(Required)

May we contact this Employer?(Required)

Yes

Present / Previous Employer

Start Date

End Date

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Supervisor & Position(Required)

Your Position/Title(Required)

Your Duties(Required)

May we contact this Employer?(Required)

Yes

Account for any periods of unemployment of (1) month duration or more.

FROM (Month/Year)

TO (Month/Year)

Specify Your Job Role/Responsibilities

Education

Please Answer All Questions: Starting with your present or most recent employer, list your employment history for the last 10 years. Include self-employment, military service, summer and part-time jobs.

School Name & Address

Major / Course of Studies

Total Years Completed

Degree

If you did not graduate, why and when did you leave school?

List any foreign language capabilities.

List any courses, licenses or certifications you have completed relating to the position you are seeking.

Course Name

School Name

Enrolled (mo/yr-mo/yr)

Overview of Course

Are you planning to pursue further studies?

Yes

Special Skills

List any special skills and/or aptitudes that you feel are relevant or related to the position for which you are applying. Please do not list organizations or activities which reveal, race, religion, age, sex, national origin or ancestry, sexual orientation, disability or political persuasion.

References

Please list (3) references other than previous employers, supervisors or relatives. By providing this information, you give this Company permission to contact the individuals listed.

Name

Direct Phone

City, State, Zip

Consent(Required)

I have read the following Terms and Conditions

Please read before signing:

ReAgg LLC 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 Vietnam‐era or special disabled veteran, or any other protected class in accordance with applicable federal, state and local laws. ReAgg LLC complies with all applicable laws prohibiting discrimination and harassment in the workplace in every location in which the Company has facilities.

This policy applies to all terms and conditions of employment, including, but not limited to hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and/or training. Interference with the ability of ReAgg LLC employees to perform their expected job duties will not be tolerated.

By signing your name below, you acknowledge and certify the following:

~ All statements made by me on this application are true and complete to the best of my knowledge.

~ I have withheld nothing that would affect this application unfavorably.

~ Any offer I may receive from the Company is contingent upon my successful completion of the Company’s total pre-employment screening process.

~ Misrepresentations or omissions may be cause for rejection or may be cause for subsequent dismissal if hired.

I understand that nothing contained in this application or in the interview process is intended to create an employment contract between the Company and myself. Should this application result in my employment, it will be an at-will relationship. I have a right to terminate my employment at any time and for any reason and the Company retains the same right.

I agree to conform to the rules and regulations of the Company.

I further understand that no representative of the Company other than a Senior Officer of the Company has any authority to enter into any agreement with me for any specified period or to guarantee some other personnel move or benefit.

I also understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me, and a Senior Officer of the Company.

I understand that past employers, educational institutions and/or the military may be contacted for references. I authorize any such organization to provide the requested information.

I further release and forever discharge the Company, its agents, its employees, and the individuals, companies, and health care providers contacted by this Company as part of its inquiries and investigations, from any and all claims, demands, damages, actions, causes of action, or suits of any kind or nature whatsoever arising from the Company’s inquiries and investigation of my credentials and information in connection with my application.

I understand that, where permissible under applicable federal, state, or local law, I may be subject to a pre-employment drug test after receiving a conditional offer of employment and must receive a negative result for illegal drug use before being permitted to commence work for ReAgg.

Under Maryland law, and employer may not require or demand, as a condition of employment or continued employment, that an individual submit to or take a polygraph examination or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.

I understand this entire statement applies to the period before, or after, I may be employed. I hereby acknowledge that I have read and understand each of the above statements. I authorize the release of information about me to this Company.

Acceptance(Required)

I agree to the Terms and Conditions

Date(Required)

Name(Required)

First Last

Resume

Please attach your resume or other pertinent documentation below. Thank you for applying with ReAgg!

Max. file size: 128 MB.