Employment Prescreening

Henderson Pit Logo
APPLICATION FOR EMPLOYMENT
THIS IS A DRUG FREE WORKPLACE
This organization does not discriminate in hiring or employment on the basis of race, color, religion, national origin, sex, disability, protected veteran’s status, on the basis of age against persons who are forty years of age or over, or on the basis of any other legally impermissible reason.
GENERAL INFORMATION
Name:*
Current Address:*
Primary Phone:*
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Other Phone:*
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How did you hear about us?*
Do You have any relatives that work for our company? If YES, Please identify them.*
If hired, can you provide proof of eligibility to work in the United States?*
Have you ever been convicted of a felony or misdemeanor? If YES, please provide date, city and state, and details of conviction. (Conviction will not necessarily disqualify an applicant for employment) *
What position are you applying for?*
Applying for:
Date available to start *
Are you under 18 years of age?
Foreign Language Skills: Please specify language and level of proficiency for each. (Basic, Moderate, Fluent)
Software Applications: Please list software applications and level of proficiency for each. (Beginner, Intermediate, Expert)
List heavy equipment you are qualified to operate.
EDUCATION
High School Attended*
College Attended
Please describe any other job related training, Certificates, Licenses, and other qualifications acquired.
Degrees Earned
PROFESSIONAL LICENSES
Please List Licenses Acquired
PREVIOUS EMPLOYMENT
Previous Employment (Please list most recent first.)*
REFERENCES
Please provide three work related references.*
NOTICE AND ACKNOWLEDGEMENT CONCERNING DRUG TESTING POLICY

This is to inform you that the Company will conduct testing where permitted to identify job applicants who may be using illegal drugs and current employees who may be under the influence of illegal drugs and/or alcohol in the workplace. You have the right to refuse to undergo testing. However, an applicant’s refusal to undergo testing will result in the termination of the pre-employment selection process, and an employee's refusal to undergo testing will result in disciplinary action up to and including discharge. An applicant who fails a test will not be hired and an employee who fails a test will be subject to disciplinary action up to and including discharge.

Acknowledgement: By typing in the Signature Box below, I am acknowledging that I have read and understand the company's drug testing policy.*
READ THOROUGHLY BEFORE SIGNING

I certify that all information contained in this Application for Employment is true and complete. Any incorrect or misleading statement( s) will render this application void. I understand that this application will remain in effect for 90 days from the date it is submitted. I must renew my application to be considered for other job openings after 90 days. I understand that completion of this application does not constitute an offer or promise of employment. I authorize the Company to contact my References and understand that, as a condition of employment, the Company will require successful completion of a background check that complies with the Company ’ s pre-employment screening policies.

In the event of my appointment to a position, I shall comply with all company policies and procedures. It is understood and agreed that any misrepresentation, omission or false statements that I make in this application will be sufficient cause for the Company to withdraw an offer of employment and/or terminate my employment.

If hired, I will be an At-Will employee and understand that my employment can be terminated by either party at any time with or without cause or notice.

Acknowledgement: By typing in the Signature Box below, I am acknowledging that I have read and understand the above written notice.*