GILMORE CONSTRUCTION, LLC 5415 S. CAMERON, SUITE 100 LAS VEGAS, NV OFFICE * FAX

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1 We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status. PLEASE PRINT POSITION(S) APPLIED FOR: SALARY DESIRED: DATE OF APPLICATION LAST : FIRST : MIDDLE OR INITIAL : NUMBER: STREET: CITY: STATE: ZIP: (S) SOCIAL SECURITY NUMBER IF YOU ARE UNDER 18 YEARS OF AGE, CAN YOU PROVIDE REQUIRED PROOF OF YOUR ELIGIBILITY TO WORK? YES NO HAVE YOU EVER FILED AN APPLICATION WITH US BEFORE? YES NO IF YES, GIVE DATE: HAVE YOU EVER BEEN EMPLOYED WITH US BEFORE? YES NO IF YES, GIVE DATE: ARE YOU CURRENTLY EMPLOYED? YES NO IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER: YES NO ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? YES NO NOTICE: NEW EMPLOYEES ARE REQUIRED TO PRODUCE VERIFICATION OF THEIR LEGAL RIGHT TO WORK IN THE UNITED STATES OF AMERICA. IF YOU ARE OFFERED EMPLOYMENT, YOU WILL BE REQUIRED TO PRODUCE SUFFICIENT DOCUMENTATION OF YOUR IDENTITY AND RIGHT TO WORK IN THE UNITED STATES, AND TO ATTEST UNDER PENALTY OF PERJURY THT THE DOCUMENTS YOU HAVE PRODUCED ARE GENUINE AND RELATE TO YOU. ON WHAT DATE WOULD YOU BE AVAILABLE FOR WORK: ARE YOU ABLE TO WORK: FULL TIME PART TIME TEMPORARY ARE YOU CURRENTLY ON LAY-OFF STATUS AND SUBJECT TO RECALL? YES NO CAN YOU TRAVEL IF A JOB REQUIRES IT? YES NO 1

2 EMPLOYMENT EXPERIENCE START WITH YOUR PRESENT OR LAST JOB, INCLUDE ANY JOB-RELATED MILITARY SERVICE ASSIGNMENTS AND VOLUNTEER ACTIVITIES. YOU MAY EXCLUDE ORGANIZATIONS WHICH INDICATE RACE, COLOR, GENDER, NATIONAL ORIGIN, DISABILITIES OR OTHER PROTECTED STATUS. EMPLOYER 1 FROM TO WORK PERFORMED: EMPLOYER 2 FROM TO WORK PERFORMED: EMPLOYER 3 FROM TO WORK PERFORMED: 2

3 REFERENCES Indicate any foreign languages you can speak, read and/or write: SPEAK READ WRITE FLUENT GOOD FAIR LIST ALL COURSES THROUGH COLLEGE UNIVERSITIES OR TRADE SCHOOLS & COURSE YEARS COMPLETE DIPLOMA HIGH SCHOOL GRAD/UNDER GRAD COLLEGE TRADE SCHOOL 3

4 It is Gilmore Constructions policy to fill every position without regards to race, color, religion, sex, age, disability, national origin, union membership or lack thereof. We Are an equal opportunity employer and select employees on the basis of qualifications. I authorize investigation of all statements contained in this application. I understand that falsifications, misrepresentations or omission of any facts called for will result in immediate dismissal or removal of my application from consideration. I authorize Gilmore Construction to secure information about my experience with former employers, educational institutions and agencies and for those parties to provide information concerning my experience, releasing all parties from any liability for doing so. Initials If Gilmore Construction employs me, I agree to conform to the rules and regulations for the Company. I also understand and agree that Gilmore Construction has job site all over this county, and that the physical address of where I am working is subject to change, as well as the hours worked and job description and wages for said job. I understand that my employment can be terminated with or without cause and with or without notice at any time at the option of Gilmore Construction or myself. I also understand that, other than the owners of Gilmore Construction, no manager, supervisor or representative of Gilmore Construction has authority to enter into any agreement for employment for any special period of time, or to make any agreement contrary to the authority or agreement contrary to the foregoing and then only in writing. Initials My signature below also certifies that I agree to the employment at-will relationships and agree to be bound by the terms and conditions of employment stated in this application if I am employed by Gilmore Construction. This application contains all the understandings and agreements between Gilmore Construction, LLC and myself concerning the nature of my employment, if any, and supersedes all prior and/or oral or written agreements, understandings, statements, representations and promises, expressed or implied between Gilmore Construction and myself, and I understand that no person who is either an agent or employee of Gilmore Construction may modify, delete, vary or contradict, whether orally or in writing, the terms and conditions of employment as outlined within this agreement. Signature Date 4

5 ADDITIONAL INFORMATION OTHER QUALIFICATIONS Summarize special job-related skills and qualifications acquired from employment or other experience State any additional information you feel may be helpful to us considering your application. 5