F.L CRANE & SONS, INC.

APPLICATION FOR EMPLOYMENT (Revised 9/1/99)

*LOCATION:

*DATE:

*POSITION APPLIED FOR:

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F. L. CRANE & SONS, INC.CONSIDERS ALL APPLICATIONS FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, HANDICAP OR DISABILITY, OR STATUS AS A VIETNAM-ERA OR SPECIAL DISABLED VETERAN IN ACCORDANCE WITH FEDERAL LAW IN ADDITION, F. L. CRANE & SONS, INC. COMPLIES WITH APPLICABLE STATE AND LOCAL LAWS PROHIBITING DISCRIMINATION IN EMPLOYMENT IN EVERY JURISDICTION IN WHICH IT MAINTAINS FACILITIES. F. L. CRANE & SONS, INC. ALSO PROVIDES “REASONABLE ACCOMODATIONS” TO QUALIFIED INDIVIDUAL WITH DISABILITIES IN ACCORDANCE WITH THE AMERICANS WITH DISABILITIES ACT AND APPLICABLE STATE AND LOCAL LAWS.

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*NAME

*CURRENT ADDRESS:

*TELEPHONE NO:

*ARE YOU OVER 18? YESNO

*I WANT TO WORK: FULLTIMEPART TIME

SPECIFY DAYS AND HOURS:

*DATE YOU CAN START WORK:

*ARE YOU WILLING TO WORK OVERTIME AS NECESSARY? YESNO

*WAGES DESIRED:

*ARE YOU WILLING TO WORK OUT OF TOWN IF NECESSARY? YESNO

*HAVE YOU EVER BEEN EMPLOYED BY THIS COMPANY? YESNO

IF YES, WHEN?

*HAVE YOU EVER BEEN CONVICTED OF A CRIME?* YESNO

IF YES STATE NATURE OF OFFENSE, WHEN, WHERE AND DISPOSITION:

*(NOTE: A CONVICTION RECORD WILL NOT NEGLECT NECESSARILY BE A BAR EMPLOYMENT. THIS INFORMATION WILL BE USED ONLY FOR JOB-RELATED PURPOSES AND ONLY TO THE EXTENT PERMITTED BY APPLICABLE LAW.

 

FEDERAL LAWS REQUIRE THAT EMPLOYEES HIRE ONLY INDIVIDUALS WHO ARE AUTHORIZED TO BE LAWFULLY EMPLOYED IN THE UNITED STATES IN COMPLIACE WITH SUCH LAWS, F. L. CRANE & SONS, INC.WILL VERIFY THE STATUS OF EVERY INDIVIDUAL OFFERED EMPLOYMENT WITH THE COMPNAY. IN THIS CONNECTION, ALL OFFERS OF EMPLOYMENT ARE SUBJECT TO VERIFICATION OF THE APPLICANTS IDENTITY AND EMPLOYMENT AUTHORIZATION, AND WILL BE NECESSARY FOR YOU TO SUBMIT SUCH DOCUMENTS AS ARE REQUIRED BY LAW TO VERIFY YOUR IDENTIFICATION AND EMPLOYMENT AUTHORIZATION UPON EMPLOYMENT.

*ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES ON A FULL-TIME BASIS FOR ALL EMPLOYERS OR FOR YOUR CURRENT EMPLOYER ONLY?

ALL EMPLOYERSCURRENT EMPLOYER ONLY

STATE NAME(S) OF ANY RELATIVE(S) IN OUR EMPLOY AND YOUR RELATIONSHIP WITH THEM:

RECORD OF EDUCATION:

*SCHOOL:

*COURSE OF STUDY:

*NO. OF YEARS COMPLETED:

*DID YOU GRADUATE? YESNO

*DIPLOMA OR DEGREE RECEIVED:

MILITARY SERVICE RECORD:

*HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES? YESNO

IF YES, LIST BRANCH AND DATES:

LIST DUTIES IN SERVICE, INCLUDING SPECIAL TRAINING, RELEVENT TO THE POSITION FOR WHICH YOU HAVE APPLIED.

PRIOR WORK HISTORY (LIST IN ORDER, LAST OR CURRENT EMPLOYER FIRST. ACCOUNT FOR ANY GAPS IN YOUR EMPLOYMENT. DESCRIBE IN DETAIL THE WORK YOU PERFORMED.)

*EMPLOYER NAME & ADDRESS:

PHONE NO:

DATES EMPLOYED: FROM TO

RATE OF PAY:

START

FINISH

SUPERVISOR’S NAME/TITLE:

REASON FOR LEAVING:

DUTIES PERFORMED:

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EMPLOYER NAME & ADDRESS:

PHONE NO:

DATES EMPLOYED: FROM TO

RATE OF PAY:

START

FINISH

SUPERVISOR’S NAME/TITLE:

REASON FOR LEAVING:

DUTIES PERFORMED:

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EMPLOYER NAME & ADDRESS:

PHONE NO:

DATES EMPLOYED: FROM TO

RATE OF PAY:

START

FINISH

SUPERVISOR’S NAME/TITLE:

REASON FOR LEAVING:

DUTIES PERFORMED:

SKILLS: LIST ANY OTHER EXPERIENCES, SKILLS OR ABILITIES THAT YOU FEEL ESPECIALLY QUALIFY FOR YOUR WORK WITH OUR COMPANY?

PERSONAL REFERENCES (DO NOT LIST RELATIVES)

________________________________________________________________________________________________

1. NAME:

ADDRESS:

PHONE:

OCCUPATION:

DATES KNOWN:

________________________________________________________________________________________________

2. NAME:

ADDRESS:

PHONE:

OCCUPATION:

DATES KNOWN:

________________________________________________________________________________________________

3. NAME:

ADDRESS:

PHONE:

OCCUPATION:

DATES KNOWN:

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PREEMPLOYMENT STATEMENT – (Please read carefully and sign the statement below.)

I understand and agree that:

1. The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, or any other materials, or during any interviews, can be justification of refusal of employed, termination from F. L. Crane & Sons, Inc. employ.

2. Any offer of employment that I may receive from F. L. Crane & Sons, Inc. is contingent upon my successful completion of the company’s total pre-employment screening process, including the company’s receiving references that it considers satisfactory, on my satisfactory completion of any postoffer pre-employment medical examination that the company may require. I also agree, if employed, to submit to a medical examination at any time at the company’s request. I hereby consent to having the results of any postoffer pre-employment or postemployment medical exams I may be required to F. L Crane & Sons, Inc.

3. I understand that as a condition of employment, I may be required to undergo and successfully pass a screening for alcohol and/or drugs. I also understand and agree that if employed. I may be required to submit to an alcohol/or drug screening at any time at the discretion of F. L Crane & Sons, Inc. I hereby consent to having the results of any such alcohol or drug screening I may be required to undergo disclosed to F. L Crane & Sons, Inc.

4. In processing my application for employment, the company may verify all the information provided by me, or may procure or have prepared a consumer or an investigative consumer report for this purpose concerning my prior employment, military record, education, character, general reputation, personal characteristics, criminal record, and mode of living. I understand that upon written request to the company, I will be informed whether an investigative consumer report was requested and given full information as to the nature and scope of this investigation.

5. I authorize and request that all my present and former employers and those individuals I have listed as personal references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities and other qualities pertinent to my qualifications for employment, I hereby releasing them from any and all liability for damages arising from furnishing the requested information.

6. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the company and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the company or myself. I further understand that no manager or representative of the company, other than the President, has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and the individual designated above.


*PLEASE SIGN YOUR NAME IN THE BOX ABOVE

 

*DATE:

 


 

INVITATION TO INDENTIFY FOR AFFIRMATIVE ACTION PURPOSES

Our company is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, disability or any other basis prohibited by federal, state, or local law. No question on this form is intended to secure information to be used for such discrimination. The company is required by federal regulations to report information as requested below. Your contribution of this information is completely voluntary and in no way affects the decision regarding your employment opportunity. The information you provide is strictly confidential and will be maintained separate from your application form.

*APPLICANT NAME:

*DATE:

*POSITION APPLIED FOR:

*PLEASE CHECK ONE: MaleFemale

*INDICATE THE APPROPRIATE RACE/ETHNIC GROUP:

Hispanic or LatinoWhiteBlack or African AmericanAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeTwo or More races

*HOW WERE YOU REFFERED TO THIS JOB?

School/CollegeWalk-InAdvertisementSearch FirmEmployee ReferralState Job ServiceOtherGovernment Agency