Application for Employment HR USE ONLY Superior Cranes Inc

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					Application for Employment
                                                                                                     HR USE ONLY
Superior Cranes, Inc                                                        Applicant No.
P. O. Box 2371                                                              Employee No.
793 US Highway 220                                                          Location:
Rockingham NC 28380                                                        Date of Employment:

    In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all
   positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related
                                        disability, or any other protected group status.

                                                   PLEASE PRINT LEGIBLY

                                                  PERSONAL INFORMATION

Name:                                                                                           Social Security No.
           First                      Middle                  Last

Present Address
                        No.           Street                               City                                    State         Zip

Permanent Address
                        No.           Street                               City                                    State         Zip

Phone No. (______) ____________________            Referred by__________________________________________________

Do you have a legal right to be employed in the United Sates?              Yes (proof Required)               No

Are you over the age of 18?           Yes            No

                                                   EMPLOYMENT DESIRED

Position Desired                                                           Date you can start

Rate of pay desired

Are you currently employed?           Yes            No       If not, when was your last day employed?

Have you worked for us before?        Yes            No              Dates: From                                    To

                                                     EDUCATION HISTORY
    Type of School                Name & Location of School                 Years           Did you                Subjects Studied
                                                                           attended        graduate?

  Grammar School

    High School

  Trade, Business or
Correspondence School

                                                                                      Applicant's Initials:
Application for Employment
Superior Cranes, Inc.                                           Applicant:

                                                GENERAL INFORMATION
        In an effort to determine your job qualifications, please check any of the following skills that you have:
                                                                                                                                   Yrs. of
   Yes         No                                                                                   Experience Details:          Experience
                          Can you weld?
                          Are you a certified welder?
                          Are you experienced enough to be a certified welder?
                          Can you cut with a torch (Burn)?
                          Can you read blueprints?
                          Can you use precision instruments?
                          Can you use transits, levels or dial indicators?
                          Can you operate forklifts?
                          Can you drive trucks?
                          Can you drive tractor-trailers?
                          Do you have your CDL?
                          Can you rig & move heavy machinery?
                          Do you know hand signals?
                          Can you finish concrete?
                          Can you lay brick or block?
                          Can you do finish carpentry?
                          Can you do piping or plumbing?
                          Can you do electrical?
                          Can you paint?
                          Can you do mechanical work?
                          Do you have supervisory experience?
                          Are you willing to travel?
                             List Other Subjects of special Study/ Work or Special Training Skills
                                                                                                                                   Yrs. of
                              Special Training or skills                                            Experience Details:          Experience

Response to the military section is voluntary:
   US Military or Naval Service                    Dates                     Special Training/Experience                      Rank

                                          Name & Address of Employer          Salary         Position            Reason for Leaving
           Month & Year

                                                                                       Applicant's Initials:
Application for Employment
Superior Cranes, Inc.                                            Applicant:

             Job offers & Employment may be conditional upon passing the following additional checks:

                                                   Criminal Background check:
                     Please verify that your full name and correct Social Security # is part of this application.

    Date of birth:
                             Month/Day & Year

                       License Record Check: See attached Motor Vehicle Report Permission Form

                                 Alochol and/or Drug Screen: See Consent Form attached.

         REFERENCES- Give below the names of three persons not related to you, whom you have known for at least one year.
             Name                                  Address                           Phone #               Business         known

                                         Authorization- Applicant MUST read and sign

   I certify that the facts contained in this application are true and complete to the best of my knowledge and understand
           that, if employed, falsified statements on this application shall be grounds for discipline and/or dismissal.

 I authorize investigation of all statements contained herein and the references and employers listed above to give you any
     and all information concerning my previous employment and any pertinent information they may have, personal or
    otherwise, and release Superior Cranes and it's representatives and agents from all liability for any damage that may
   result from utilization of such information. I also release employers and other persons named herein from all liability for
                                     any damages on account of furnishing such information.

   I agree and understand that certain listed checks will be performed and that the results of these checks will determine
                                whether or not my application for employment is rejected.

 I also understand and agree that no representative of Superior Cranes, Inc. has any authority to enter into any agreement
  for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing
    and signed by the Company President. I agree and understand that this application is made for at-will employment.

  I further certify that I am a genuine applicant for employment and this application is being submitted soley for the purpose
                                of seeking employment with the employer and for no other reason .

  This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the
                     Americans with Disabilited Act (ADA) and other relevant federal and state laws.

 I certify that I have read and understood all of this employment application. If hired, I agree to abide by all the rules and
                                                policies of Superior Cranes, Inc.

Date:                                                         Applicant's Signature:
                             Superior Cranes, Inc.
                                  Rockingham, North Carolina


I fully understand that it is Superior Cranes, Inc. policy to request a blood alcohol and/or
drug screen which includes marijuana and other controlled/illegal substances.

I understand it is my responsibility to advise the person administering the physical
examination if I am currently taking any prescribed or over-the-counter medications.

I agree to this test and will not hold Superior Cranes, Inc. liable for any actions or
findings associated with this blood alcohol and/or drug screening test.

I understand that the results of this blood and/or drug-screening test will be released to
Superior Cranes, Inc.

I agree to reimburse Superior Cranes, Inc. in the amount of $60.00 (the cost of the drug
screen) if I do not pass the test.

Signature of Applicant ____________________________ Date ____________

Social Security Number _______________________

Witness ______________________________________ Date _____________
Application for Employment
Superior Cranes, Inc.                                             Applicant:

                                                    AFFIRMATIVE ACTION DATA

                                             Information for Federal and State Reporting
                      Optional Invitation to self-Identify- ( Will be kept in a seperate, Confidential File)
   Superior Cranes, Inc. is committed to an affirmative action program which provides for the recruitment, employment and
    advancement of minorities, females and indivuduals with disabilities and veterans. To implement this Program more
    successfully, we request that you provide the following information. Completion of this form and supplying your social
   security number is voluntary. A decision not to provide this information will not result in any adverse treatment of your
                         application for employment. Thank you for voluntarily completing this form.

       Referral          How were you referred to our Company?
                                         Friend                                Newspaper (name)
                                         Walk-In                               Employment Security Commission
                                         Employee                              other (specify)

       Gender:                           Male                                  Female
    Date of Birth:
Race/Ethnicity: Which race or ethnicity do you consider yourself to be?
                                         Black/African American
                                         American Indian
                                         Alaskan Native
                                         Hispanic or Latino (please specify- ex: mexican, cuban)
                                         Native Hawaiian or other Pacific Islander
                                         Other (please specify)
                                                           Veteran Status:
  Are you a veteran of the US armed forces?                Yes                      No     If yes, please check one of the following:
                                         Disabled Vietnam-era Veteran (DV)*                              Vietnam-era veteran (V V)*
                                         Other veteran (OV)                                              Disabled Veteran (DO)
*Vietnam-era veteran is defined as either:
1. A veteran who served in the Republic of Vietnam during the perior of February 28, 1961 an ending May 7, 1975; OR
2. A veteran who served during the period beginning Augusy 5, 1964 and ending May 7, 1975.
                                                           Disabilty Status:

   Superior Cranes, Inc. commits to making a reasonable accommodation to the known physical and mental limitations of
  qualified individuals with disabilities and qualified disabled veterans, unless such accommodation would impose an undue
 hardship on the conduct of its business. In determining the extent of its obligations, Superior Cranes will consider business
                                necessity and financial costs and expenses, among other factors.

Do you have a physical or mental disability which requires a reasonable accommodation?
                                                        Yes                    No
If YES, please detail the accommodation required:

Signature of Applicant:                                                                                  Date:

Description: Employment Background Check North Carolina document sample