Application for Employment

All Fields are Required Unless noted otherwise with *

Note: Transmitting this information via internet, may not be secure.
If concerned, please contact our Human Resource Department to provide this information.

CROSSLAND HEAVY CONTRACTORS is committed to provide equal employment opportunity to all qualified persons in all job classifications in recruitment, selection and promotion without regard to race, sex, color, religion, age, national origin, veteran status, or disability.

Completion of this form will assist us in complying with Federal Regulations 41 CFR 60-1.4, 60-1.7, and 60-2.  Submission of this information is VOLUNTARY and is not considered in employment decisions.  This form will be kept separate from the employment application form.  This form and your employment application are confidential.

Sex:
Race / Ethnic Group:

Caucasian
Black
Hispanic
Asian/Pacific Islander
American Indian/Native Alaskan
Referral Source:
 Walk-In
Newspaper Advertisement
TV Advertisement
Employee Referral
Rehire
School Referral
State Job Service
Agency

Position(s) Applying For:
Last Name:

First:
Middle: *
 SSN:
Address:
City:
State:
Zip:
Phone:
Mobile/Other: *
 Email:
If you are under 18, and it is required, can you furnish a work permit? Yes No
If no, please explain:
Have you ever been employed here before? Yes No
If yes, give dates and positions:
Are you legally eligible for employment in this country? Yes No
Are you able to meet the attendance requirements of this position? Yes No
Have you ever plead "guilty" or "no contest" to, or been convicted of a crime? Yes No
Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of violation, rehabilitation and position applied for will be taken into account.
If "yes", please provide dates and details.
Date Available for Work:
 Desired Salary Range:
 Driver's License Number:
(If driving is an essential job function)
Type of Employment Desired: Full-time Part-time Temporary Seasonal Educational Co-op
Skills & Qualifications:
Educational Background:
  Years Completed Did You Graduate? Course of Study
High School: Yes No
College: Yes No
Other: Yes No
References:
At Least one reference is required*
Name: Telephone: Years Known:

Employment History:
At Least one past employer is required*
Provide the following information of your past four (4) employers, assignments or volunteer activities, starting with most recent.

From:
 To:
 Employer:
 Phone:
Job Title:
 Address:
Immediate Supervisor & Title:
 Summarize the nature of work performed and job responsibilities:
May we contact for reference:
Reason for leaving:
 Hourly Rate / Salary:
Start $: Per: Final $: Per:

 

From:
 To:
 Employer:
 Phone:
Job Title:
 Address:
Immediate Supervisor & Title:
 Summarize the nature of work performed and job responsibilities:
May we contact for reference:
Reason for leaving:
 Hourly Rate / Salary:
Start $: Per: Final $: Per:

 

From:
 To:
 Employer:
 Phone:
Job Title:
 Address:
Immediate Supervisor & Title:
 Summarize the nature of work performed and job responsibilities:
May we contact for reference:
Reason for leaving:
 Hourly Rate / Salary:
Start $: Per: Final $: Per:

 

From:
 To:
 Employer:
 Phone:
Job Title:
 Address:
Immediate Supervisor & Title:
 Summarize the nature of work performed and job responsibilities:
May we contact for reference:
Reason for leaving:
 Hourly Rate / Salary:
Start $: Per: Final $: Per:

Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume' or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminated in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the forgoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete and I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement