Application for Employment Thank you for your interest in joining the Reliant-Diesel team. Please complete this application in its entirety, providing thorough and accurate information in all required fields. We look forward to reviewing your qualifications. APPLICATION FOR EMPLOYMENT(Valid for only 90 days) Reliant Diesel is An Equal Opportunity Employer Personal InformationName *Last Name *Email Address *Phone *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweLegal Right to Work *Only U.S. Citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity?YesNoAge Verifaction *Are you 18 years of age or older?YesNoBackgroundEducationDegree or CertificationGraduation DateMajor/Area of StudyInstitution NameEmployment ExperienceALL FORMER JOBS (List most recent job first.) Account for all time periods including unemployment, self-employment and military service. (Upload a Resume or Separate paper(s), if necessary.)Company Name *Job Title *Employment Period *Job Responsibilities *Company NameJob TitleEmployment PeriodJob ResponsibilitiesOther SkillsList any other job-related skills or qualifications that support your application in the space provided below.Honors Received:Please list any honors received in the space provided.Name Change or Assumed Name *In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name that you previously used?YesNoYes: Change/Assumed NameSince, you answered "Yes" to the questions. Please write in this place any identify names and relevant dates.Prior Educational ExperienceHave you had prior educational experience which relates to the job for which you are applying?YesNoYes: Prior Educational ExperienceSince, you answered "Yes" to the question. Please write in the space below prior educational experience and dates.Dismissed or Forced to Resign *Have you ever been dismissed or forced to resign from any employment?YesNoYes: Dismissed or Forced to ResignSince, you answered "Yes" to the question. Please explain in the space below.Are you a veteran of the U.S. Military Service? *YesNoU.S. Military ServiceActive Duty Begin DatePlease provide your beginning date of active dutyActive Duty End DatePlease provide your end date of active dutyDate of DischargePlease provide your discharge dateSelectChoose the branch of Service you were inWhat branch of Service?U.S. Army Active Duty (Regular Army)Army ReserveArmy National GuardU.S. Marine Corps Active DutyMarine Corps ReserveU.S. Navy Active DutyNavy ReserveU.S. Air Force Active DutyAir Force ReserveAir National GuardU.S. Coast Guard Active Duty (Coastguardsmen)Coast Guard ReserveEmergency ContactIn Case of Eergency, Notify:First Name *Last NameRelationship to You *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Do you have transportation to work? *YesNoWill you work overtime if asked? *YesNoAlternative Transportation DetailsSince you indicated you do not have transportation, please describe the reliable method you will use to commute to the South Daytona location (e.g., public transit schedule, confirmed carpool arrangement, ride-sharing service, etc.) to ensure timely arrival for all shifts.Are there any hours, shifts or days you will not work? *YesNoYes: Hours/Shifts/Days - Will Not WorkSince, you answered "Yes" to the question. Please explain.Do you have any friends or relatives who work here? *YesNoYes: Friends or Relatives EmployedFirst NameLast NameRelationshipFirst NameLast NameRelationshipCurrent EmploymentCurrent Employment Information (if applicable):Are you now employed? *YesNoAre you on a layoff? *YesNoAre you subject to recall?YesNoDescription for Layoff and Recall StatusPlease briefly explain the reason for the current layoff (e.g., seasonal work, company downsizing, project completion) and clarify the expected timeframe or conditions under which you may be recalled to your previous position. This information helps us assess your availability.May we contact your present Employer? *YesNoCan we contact your current or previous employers? *YesNoPermission to Contact Prior EmployersPlease list the former employer(s) you do not wish for us to contact at this time, along with a brief explanation of the reason (e.g., currently employed there, sensitive project, etc.). We will respect this request and will not reach out to the specified employer(s) without your explicit permission.Character ReferencesBelow, please provide three character references. These individuals should not be relatives and you should have known them for at least one year.Relationship *Your Relationship to this ReferenceSelect *Years KnownKnown ForLess than 1 Year1 - 3 Years4 - 6 YearsMore than 6 YearsOccupation *Reference's OccupationName *Phone *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweCrucial Application RequirementIn order to be considered for the position, you must specifically reply to the screener question.Describe, step-by-step, how to change the oil on a marine diesel engine. *Use the space provided below to provide your answer to the questionAdditional InformationHave you previously applied for employment with Reliant-Diesel?Have you ever applied here before? *YesNoDatePrevious Application DateAdditional InformationIndicate whether you have previously been employed by Reliant-Diesel.Have you ever been employed here before? *YesNoDate of Last EmploymentIf you answered "Yes," please provide the exact date your prior employment ended with our company.Additional InformationIs there anything else you'd like us to consider as part of your application? Please tell us below.Resume UploadUpload your resume here (if applicable).Choose FileNo file chosenDelete uploaded fileConsent *Agreement and Acknowledgment By checking this box, you agree to and acknowledge both the Notice to Applicants and the Applicant's Statement (linked here).Signature *Start signing your signature hereYour browser does not support e-Signature field. EEO StatementEqual Employment Opportunity EmployerThis employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap or marital status. We assure you that your opportunity for employment with this Employer depends solely upon your qualifications.ApplySave as DraftPlease do not fill in this field.