Application for Employment

Application for Employment

Hoosier Crane Service Company is an EOE/AA Employer. Women, Veterans, and Individuals with Disabilities are encouraged to apply
Position(s) applied for
Date of Application

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Telephone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referral Source

AdvertisementWalk-InGovernmentCustomer:Employee:Employment AgencyOther
Are you legally authorized to work in the United States of America

YesNo
Do you have a valid driver’s license

YesNo
Are you at least 18 years of age

YesNo
Have you every filled out an application here

YesNo
Have you ever been fired or asked to resign from a job

YesNo
If yes, when
What salary do you expect to received if you are employed
Date available to begin work

MonthDayYear
Date
Type of employment desired

Full TimePart
Have you ever been arrested for or convicted of a crime, other than a minor traffic violation, that has not been expunged/sealed/restricted by a court

YesNo
If yes, please explain

Availability: Please indicate the earliest and latest you are able to work: (some of our positions are on call)

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Earliest
Latest

Are you able to meet the attendance expectations of this position

YesNo

Level of education

	Course of Study	City, State	Degree, Diploma	Name	Graduated or years Completed
High School
Associate
Undergraduate
Graduate
Other

List any experience, certification, special skills, or knowledge which you feel may be relevant to the job you are seeking
List any computer software/equipment and other office equipment that you can use proficiently

References
Please list names and contact information of three business/work references who are not related to you, that do not work here, and are not previous supervisors. These can be from paid or volunteered positions. If not appliable, list three school references.
Name
Contact Information
Capacity and Years know.
Name
Contact Information
Capacity and Years know.
Name
Contact Information
Capacity and Years know.

Employment History
List all employment (including self-employment, summer, part-time jobs) during the last ten (10) years prior to the date of this applications. If more space is needed, please attach additional sheets. Begin with the most current/recent employment.
Employer
Address
Telephone Number
Dates Employed
From

MonthDayYear
Date
To

MonthDayYear
Date
Job Title
Immediate Supervisor
Summarize the nature of the work performed and job responsibilities
Reason for Leaving
May we contact for a reference

YesNo
Employer
Address
Telephone Number
Dates Employed
From
To
Job Title
Immediate Supervisor
Summarize the nature of the work performed and job responsibilities
Reason for Leaving
May we contact for a reference

NoNo
Employer
Telephone Number
Address
Dates Employed
From
To
Job Title
Immediate Supervisor
Summarize the nature of the work performed and job responsibilities
Reason for Leaving
May we contact for a reference

YesNo

It is the policy of Hoosier Crane Service Company (HCS) to maintain a safe, healthy and productive work environment for all of its employees/apprentices/interns. Because of this goal, HCS requires candidates for any level of employment to pass a drug/alcohol screening test covering illegal substances and legal substance subject to abuse. The process includes the candidate submitting a post offer blood/urine/hair specimen to the appropriate medical provider. Refusal will result in the disqualification for further employment consideration. I understand that if I am offered employment, I will be required to submit to this screening test.

It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from any and all liability the employer and its representatives for seeking such information.

The employer is an EOE/AA employer. Veterans, Women, and Individuals with Disabilities are encouraged to apply. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law. I understand it is the company’s policy not to refuse to hire a qualified individual with a disability because of this person’s need for accommodation that would be required by the ADA.

This application is current for 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

I understand that if employment is offered and accepted that I agree to adhere to the policies, procedures, rules, and regulations of the company and hereby acknowledge that these policies, procedures, rules, and regulations can and may be changed or modified by the company at any time without notice.
Signature

Clear
Date

MonthDayYear
Date

Voluntary Self-Identification of Disability
Name
Date

MonthDayYear
Date
Employee ID
if applicable
Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we
must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you
want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had
such a condition, you are a person with a disability. Disabilities include, but are not limited to:
- Alcohol or other substance use disorder (not currently using drugs illegally)
- Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
- Blind or low vision
- Cancer (past or present)
- Cardiovascular or heart disease
- Celiac disease
- Cerebral palsy
- Deaf or serious difficulty hearing
- Diabetes
- Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
- Epilepsy or other seizure disorder
- Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
- Intellectual or developmental disability
- Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
- Missing limbs or partially missing limbs
- Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
- Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
- Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
- Partial or complete paralysis (any cause)
- Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
- Short stature (dwarfism)
- Traumatic brain injury
Please check one of the boxes below:

Yes, I have a disability, or have had one in the pastNo, I do not have a disability and have not had one in the pastI do not want to answer
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Application for Employment

References

Employment History

Affirmative Action Voluntary Information

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

How do you know if you have a disability?