Employment Application

Position You Are Applying For*
Number of Years Experience*
Date Available to Begin Work*
MM slash DD slash YYYY
Desired Salary / Hourly Rate*
must be dollar amount
The following information is requested in order to help us make the best possible placement within the company. All portions of this application pertaining to you must be completed. We appreciate the time you spend filling out this application form. Crofton Industries, in accordance with State and Federal laws, does not discriminate on the basis of age, race, religion, color, sex, national origin, marital status, physical or mental handicap or arrest record. Crofton Industries also is required by law, by virtue of its contracts with federal government, to take affirmative action to employ women, minorities, otherwise qualified handicapped individuals and Vietnam and disabled veterans.
General Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone Number*
- Home
- Cell
- Other
Secondary Phone Number
- Home
- Cell
- Other
Email*
Are you legally entitled to work in the United States?*
- Yes
- No
Are you currently employed?*
- Yes
- No
Have you every applied to work for Crofton before?*
- Yes
- No
If yes, when?*
Have you ever been employed by Crofton before?*
- Yes
- No
If yes, when?*
Do you have a TWIC card?*
- Yes
- No
Are you willing and available to work overtime, out of town, nights, weekends, and holidays when necessary?*
- Yes
- No
If security clearance to shipyards, military bases, and other government installations is necessary, can this be achieved?*
- Yes
- No
Do you have a valid driver’s license?*
- Yes
- No
How were you referred to Crofton?*
- Online Search
- Word of Mouth
- Current Employee
- Job Ad
- Vocational School
If yes, who?*
If yes, which one?*
If yes, which one?*
Will you be submitting a resume?*
- Yes
- No
Resume Upload*
Max. file size: 10 MB.
Education
Highest degree of education achieved?
High School
School Name Years Completed Degree Major and / or Specialization
College
School Name Years Completed Degree Major and / or Specialization
Graduate School
School Name Years Completed Degree Major and / or Specialization
Trade / Vocational School
School Name Years Completed Degree Major and / or Specialization
Courses Presently Studying
Training, Licenses, and / or Certifications
Employment History: Please list most recent positions first
Employer Name*
Still In Business?*
- Yes
- No
Employer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone*
Date of Employment Start*
Curently Employed?
- Yes
- No
Date of Employment End
Positions Held*
Supervisor Name*
First Last
Salary (Starting and Ending)
Reason for Leaving
May we contact this employer?*
- Yes
- No
Employer Name
Still In Business?
- Yes
- No
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone
Date of Employment Start
Curently Employed?
- Yes
- No
Date of Employment End
Positions Held
Supervisor Name
First Last
Salary (Starting and Ending)
Reason for Leaving
May we contact this employer?
- Yes
- No
Employer Name
Still In Business?
- Yes
- No
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone
Date of Employment Start
Curently Employed?
- Yes
- No
Date of Employment End
Positions Held
Supervisor Name
First Last
Salary (Starting and Ending)
Reason for Leaving
May we contact this employer?
- Yes
- No
References
Please do not list relatives, teachers, or former employers
*
Name Occupation Telephone # Years Known
Terms and Conditions
I acknowledge that consideration for employment is contingent on the results of a reference and background check. Therefore, I hereby authorize the company to (1) investigate the truthfulness of all statements made on this application; (2) contact any current or former employer and other listed references or any other persons who can verify information; and (3) discuss the results of any investigation with other employees of the company involved in the hiring process. In addition, I give my consent for (1) the company to inquire into my prior work and school records of any employers or school and to investigate my personal history, including police records and (2) all contacted person including any current or former employers to provide such information concerning me as the company request, including delivery of my personnel records, and I release al, persons from liability for any damage that may result from providing information to the company.

I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I agree to conform to the rules and regulations of the company, and understand that my employment will be at will and that employment and compensation can be terminated, with or without notice, at any time, at the option of either the company or myself. I further understand that no personnel recruiter or interviewer or other representative of the company, other than the President, has any authority to enter into any agreement for employment for any specified period of time.
*
- I agree to the terms and conditions listed above.
Name
This field is for validation purposes and should be left unchanged.

Name	Occupation	Telephone #	Years Known

Employment Application

General Information

Education

Employment History: Please list most recent positions first

References

Terms and Conditions