CRS OneSource Employment Application

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Please fill out this form, and click the submit button, to submit your application.

Position applied for *

Name *

Last, First, Middle, Maiden

Present Address *

Telephone *

Are you at least 18 years old or older? *

Yes

If applying for a driving position, are you at least 21 years old or older? *

Yes

Salary desired *

Please be specific.

How many hours can you work weekly? *

Have you ever been employed by CRS OneSource? *

Yes

Employment desired *

FULL-TIME only

PART-TIME only

FULL or PART-TIME

Are you willing to work: *

Day Shift

Night Shift

Any Shift

Educational History *

Please list all educational history, including a list of schools attended (name + address), # of years completed, and any major/degree.

Have you ever been convicted of a crime? *

Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

References *

Please list two references other than relatives or friends.

Do you have a driver's license? *

Yes

What is your means of transportation to work? *

License number *

State of issue *

License Type

Operator

Commercial (CDL)

Chauffeur

Accident History

Please list any accidents or moving violations within the past three years.

Have you ever been in the Armed Forces?

Yes

Clear selection

Are you now a member of the National Guard?

Yes

Clear selection

Military History

Please list your specialty, date entered, and discharge date as appropriate.

Work Experience *

Please provide a list of work experience from most recent to least recent for the last 5 years. Please include employer address, name of supervisor, dates of employment, salary, title, and reason for leaving.

Additional Information

Please summarize any additional information necessary to describe your qualifications for the specific position you are applying for.

May we contact your current employer? *

Yes

Did you complete this application yourself? *

Yes

Other:

I certify that all information given on this application is true, correct, and complete to the best of my knowledge. If employed by CRSOneSource, I agree to abide by its rules and regulations. I understand that discovery of misrepresentation or omission of facts herein will make me ineligible for employment or be cause for immediate dismissal. I agree to furnish additional information as may be required to complete my employment file. 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 the company from all liability for any damage that may result from utilization of such information. I also understand that my employment may be subject to the successful completion of an employment physical examination, and that my continued employment may be conditioned upon satisfactorily continuing to meet job-related physical and mental requirements. If offered employment, I agree to submit to a job-related physical examination performed by a qualified medical person of CRSOneSources’ choice. Such examination shall be paid for by CRSOneSource. I also agree that all information concerning said physical examination can be supplied to CRSOneSource, or an authorized agent upon request. I further understand that CRSOneSource is committed to providing a safe, productive, and efficient work environment and to employing a work force free from the use of illegal drugs, either on or off the job. CRSOneSource has established a pre-employment drug testing policy. Pre-employment testing of applicants: As a condition of hiring, applicants will be required to take a drug test. Applicants will provide a urine sample for drug testing. The test results will be maintained in a confidential file and only released to CRSOneSource, its representatives, or as otherwise authorized or required by law. The applicant releases CRSOneSource and its representatives from all liabilities relating to the drug testing carried out under this policy, including, without limitation, the release of the test results. Any applicant who fails to report for a test, refuses to take a test, fails to provide a specimen, tampers with a test specimen or who is identified with verified positive test results will be denied employment at that time. I understand that this is an application for employment and that no employment contract, either express or implied, is being offered. I also understand that if employed, such employment is for an indefinite period and can be terminated at will by either party, with or without notice, at any time, for any or no reason, and is subject to change in wages, conditions, benefits, and operating policies.

Please sign this by typing your name and date *

Applicant Invitation to Self-Identify This company is subject to Executive Order 11246, as amended, which requires Federal contractors to ensure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex, or national origin. We are therefore requesting information about the race and gender of our applicants in order to comply with government reporting requirements and in order to ensure equal employment opportunity.

Gender

MALE

FEMALE

I CHOOSE NOT TO SELF-IDENTIFY

Clear selection

Race

WHITE (not Hispanic or Latino)

BLACK or AFRICAN AMERICAN (not Hispanic or Latino)

HISPANIC OR LATINO

ASIAN (not Hispanic or Latino)

AMERICAN INDIAN/ALASKA NATIVE (not Hispanic or Latino)

NATIVE HAWAIIAN or PACIFIC ISLANDER (not Hispanic or Latino)

TWO or MORE RACES (not Hispanic or Latino)

I CHOOSE NOT TO SELF-IDENTIFY

Clear selection

This company is also subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment veterans in the following classifications:  A “disabled veteran” is one of the following: o a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or o a person who was discharged or released from active duty because of a service-connected disability.  A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.  An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.  An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Do you identify as a protected veteran?

I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE

I AM NOT A PROTECTED VETERAN

Clear selection

Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2017 Page 1 of 2 Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. . How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)

Please check one of the boxes below: *

YES, I HAVE A DISABILITY (or previously had a disability)

NO, I DON’T HAVE A DISABILITY

I DON’T WISH TO ANSWER

Required

Please sign this by typing your name and date. *

Reasonable Accommodation Notice Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp . PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Below are questions for driver applicants only

Driver's licenses held during the past 3 years. Please include state issued, license number, type of license, and expiration date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

Clear selection

If you answered "Yes" to the above question, please give details.

Class of equipment (Check all that apply)

Straight Truck

Tractor & Semi-Trailer

Years of experience on a Straight Truck?

Years of experience on a Tractor & Semi-Trailer?

List states operated in for the last five years.

Do you have any safe driving awards?

Accident record for the past five years. Please include dates, nature of the accident, and if there were any fatalities or injuries.

Traffic convictions and forfeitures for the past five years (other than parking violations)

Submit

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