Employment Application

Date of Application: *

Cell Phone #: *

Home Phone #:

First Name: *

Middle Name: *

Last Name: *

Street Address / Apartment #: *

City: *

State: *

Zip Code:

Social Security #: *

Drivers License #: *

Drivers License State: *

Drivers License Expiration Date: *

Are you at least 18 years of age? *

Yes No

Will you submit to a pre-employment drug screening test? *

Yes No

Do you have reliable transportation? *

Yes No

Have you ever worked for Henson Construction Co? *

Yes No

Are you able to work overtime or 40 hours per week, if required? *

Yes No

(1) Employer Name: *

(1) Employer Telephone #: *

Please enter a valid phone number.

(1) Employer Address:

(1) Employer City: *

(1) Employer State: *

(1) Employer Zip Code:

(1) Start Date: *

(1) End Date: *

(1) Title of Position: *

(1) Duties / Responsibilities: *

(1) Average Hours Per Week: *

(1) Hourly Wage: *

(2) Employer Name:

(2) Employer Telephone #:

Please enter a valid phone number.

(2) Employer Address:

(2) Employer City:

(2) Employer State:

(2) Employer Zip Code:

(2) Start Date:

(2) End Date:

(2) Title of Position:

(2) Duties / Responsibilities:

(2) Average Hours Per Week:

(2) Hourly Wage:

(3) Employer Name:

(3) Employer Telephone #:

Please enter a valid phone number.

(3) Employer Address:

(3) Employer City:

(3) Employer State:

(3) Employer Zip Code:

(3) Start Date:

(3) End Date:

(3) Title of Position:

(3) Duties / Responsibilities:

(3) Average Hours Per Week:

(3) Hourly Wage:

(1) Training / Certifications / Skills

(2) Training / Certifications / Skills

(3) Training / Certifications / Skills

(4) Training / Certifications / Skills

STATEMENT OF CERTIFICATION BY APPLICANT

By signing this application, I certify that the facts set forth or contained in this employment application are true and complete to the best of my knowledge. I authorize investigation of all answers, statements and information contained herein. Specifically, I authorize Henson Construction Co. to make all necessary and appropriate investigations or background checks to verify the accuracy of the information provided, and to obtain reference information of / on my work performance. Furthermore, I authorize all persons, companies, corporations, schools, former employers, law enforcement agencies, state bureau of criminal investigators, doctors, physicians, departments of motor vehicle, automated workforce screeners or consumer investigators to supply or disclose any information concerning my background. I release, discharge and hold harmless Henson Construction Co., and each of the above, from any and all liability, of whatever kind or nature, which could result from obtaining and having an employment decision based on such information.

I understand that if I become employed, falsified facts, falsified statements, misrepresentations, or factual omissions, of any kind, on this application, may be sufficient grounds or basis for dismissal. Furthermore, if I become employed, I will fully adhere to the policies, rules and regulations of employment of Henson Construction Co. However, I understand that neither the policies, rules or regulations of employment of Henson Construction Co., or anything stated or claimed during a potential interview process shall be deemed to constitute the terms of an implied employment contract or agreement. Additionally, I understand this application does not constitute terms of an implied employment contract or agreement. I understand that if I am hired, I will be required to produce proof that I have a legal right to work in the United States of America (U.S.A.) in accordance with the Immigration Reform and Control Act of 1986. Finally, I understand that any employment offered is for an indefinite duration and "at will," and that either I or Henson Construction Co. may terminate my employment at any time with or without notice, prior notice or cause.

Signature of Applicant: *

Clear

Print Name: *

Date of Application: *

EQUAL EMPLOYMENT OPPORTUNITY & AFFIRMATIVE ACTION POLICY STATEMENT

It is the policy of HENSON CONSTRUCTION CO. (the “Company) to comply with the U.S. Department of Labor regarding Equal Employment Opportunities (EEO) and the Affirmative Action (AA) provisions of Executive Order 11246, as amended. The Company is committed to the principle of equal employment opportunities and affirmative action for all employees and applicants and to provide a work environment free of discrimination and harassment. All Company decisions regarding employing, promoting, hiring, training, upgrading, transferring, demoting, terminating, increasing compensation, reducing compensation, employee benefits, or any other business need of the Company are based on an individual’s aptitude, ability and qualification without regard to race, ethnicity, national origin, ancestry, color, age, creed, religion, belief, gender, marital status, pregnancy, gender orientation, gender preference, gender identity, disability, handicap, veteran status, military status, Vietnam-era veteran status, or any other legally protected status (Federal or Oklahoma). Any provisions or actions of the Company, its employees, or subcontractors that conflict with this principle are strictly prohibited.

Signature of Acknowledgement: *

Clear

Print Name: *

Date of Application: *

VOLUNTARY APPLICANT SURVEY (Optional): Responses to the following survey will be used to assist Henson Construction Co. in complying with state and federal record-keeping and reporting requirements in regards to equal employment opportunities, affirmative action, civil rights laws, and government contracts. This information is meant for analytical and reporting purposes and considered highly confidential. Submission of this information is optional and voluntary, and refusal to provide it will not subject an applicant to adverse treatment. Likewise, responses to this survey will not be used to evaluate applicants for employment nor subject an applicant to adverse treatment. If employed, self-identification of this information may become necessary. Your cooperation is important and appreciated.

Date of Application:

First Name:

Last Name:

Date of Birth:

Gender (Check One):

Male Female I choose not to disclose

Race or Ethnicity (Check One):

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. Black or African American - (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. White - (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Asian - (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example: Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Native American Indian or Alaska Native - (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Native Hawaiian or Pacific Islander - (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Two or More Races - (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. I choose not to disclose.

Protected Veteran Classification (Check All That Apply):

I am not a veteran (I do not serve or have not served in the military). Disabled Veteran - 1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A veteran who was discharged or released from active duty because of a service-connected disability. Recently Separated Veteran - Any veteran discharged or released from active duty within the last three years, beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval or air service. Active Duty Wartime or Campaign Badge Veteran - A veteran who served on active duty in the U.S. military, ground, naval or air service during one or more periods of war outlined in 38 U.S.C. § 101, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. Armed Forces Service Medal Veteran - A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces Service Medal was awarded pursuant to Executive Order 12985 (61 FR 1209). I served in the military, but do not fall into any of the protected categories listed above. I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

DISABILITY

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness
Deafness
Cancer
Diabetes
Epilepsy
Missing limbs or partially missing limbs
Multiple sclerosis (MS)
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Bipolar disorder
Major depression
HIV / AIDS
Autism
Cerebral palsy
Schizophrenia
Muscular dystrophy
Intellectual disability

Disability (Check One):

Yes, I have a disability (or previously had a disability). No, I don't have a disability. I choose not to disclose.

CONTACT INFORMATION

PERSONAL INFORMATION

EMPLOYMENT HISTORY

TRAINING / CERTIFICATIONS / SKILLS

STATEMENT OF CERTIFICATION BY APPLICANT & EEO / AFFIRMATIVE ACTION POLICY ACKNOWLEDGEMENT

VOLUNTARY APPLICANT SURVEY (OPTIONAL):