Application for Employment

Crown Laboratories Employment Application

All fields denoted with an "*" are required.

AN EQUAL OPPORTUNITY EMPLOYER
We do not discriminate on the basis of race, religion, national origin, color, sex, age, disability, or veteran status. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job related performance factors.
The fact that this application has been provided to you does not necessarily mean there are positions available and does not in any way obligate the Company to offer you employment.


Identification Information

Contact Information

United States Military Service Record

Education
High School:
Most Relevant Degree:
Additional Degree:
Additional Skills:

Criminal Record
iNote: A "Yes" response does not automatically disqualify an applicant from employment.

On the following section it is extremely important that you give as complete and accurate information as you can concerning your work record.


Employment Record
(BEGIN WITH YOUR CURRENT OR MOST RECENT JOB)

Current/Most Recent Employment:
Dates you were employed:
List your last (or current) hourly rate of pay; or annual salary (Ex: $10/hr or $25,000.00/yr):
Other supervisors you worked for with this Company:
List all jobs you performed for this Company and the approximate length of time you worked at each job:
POSITION EQUIPMENT/JOB DUTIES LENGTH OF TIME IN JOB

Employment Record - Continued
Dates you were employed:
List your hourly rate of pay; or annual salary (Ex: $10/hr or $25,000.00/yr):
Other supervisors you worked for with this Company:
List all jobs you performed for this Company and the approximate length of time you worked at each job:
POSITION EQUIPMENT/JOB DUTIES LENGTH OF TIME IN JOB

Employment Record - Continued
Dates you were employed:
List your hourly rate of pay; or annual salary (Ex: $10/hr or $25,000.00/yr):
Other supervisors you worked for with this Company:
List all jobs you performed for this Company and the approximate length of time you worked at each job:
POSITION EQUIPMENT/JOB DUTIES LENGTH OF TIME IN JOB

References
Name Phone Number Relationship

IMPORTANT!!!
YOU MUST READ THE FOLLOWING STATEMENTS CAREFULLY.
TYPE YOUR INITIALS IN THE CORRESPONDING BOX PER STATEMENT AS PROVIDED.
YOU MUST TYPE YOUR NAME AND ENTER THE CURRENT DATE AT THE BOTTOM OF THIS FORM.
This Company is an Equal Opportunity Employer and considers all applicants for employment without regard to race, color, sex, religion, national origin, age, or mental or physical disability ( unless the disability prevents acceptable performance or creates a safety hazard with the work involved) or veteran status. (Initials)*
I understand that either misrepresentations or omissions of facts called for on this application are causes for rejection of this application, or for subsequent dismissal from employment. (Initials)*
I understand and agree that because employment at this Company is based on mutual consent, the right of employment relationship "At Will" is recognized and affirmed as a condition of employment irrespective of any other company policy, rule or regulation. (Initials)*
I understand that before I am employed I may be required to give a Company-directed demonstration or complete additional examinations to indicate my level of ability to perform certain jobs/tasks for which I may be considered for employment. (Initials)*
If I am employed, I agree to comply with and be bound by the safety and work rules and other rules, regulations and policies of the Company. (Initials)*
I agree, if requested, to submit a post-offer medical examination which may include a drug test; and periodic medical examinations (including random drug tests) after I am employed, for any reason, at the Company's discretion. (Initials)*
I understand and accept that I must successfully complete Crown's Introductory Period if I am hired. (Initials)*
I authorize a blanket investigation of all statements contained in this application and do hereby release any and all persons, companies, educational institutions, or agencies responding to such investigation from any liability for any damage due to releasing information pertaining hereto. (Initials)*
I understand that in the event my application for employment is accepted, the effective date of acceptance and of my employment shall be the date I actually begin work. (Initials)*
I understand that I will be required to provide the Company with appropriate documentation to establish that I am either a U.S. citizen, U.S. national, or, if neither, that I am legally authorized to work in the United States. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the U.S. and to complete the required employment eligibility document form. (Initials)*

Completion of this section of the application is voluntary.
Please be advised that this information is NOT a part of an official application for employment.

Our Company is or seeks to qualify as a Government contractor subject to Executive Order 11246; Section 503 of the Rehabilitation Act of 1973, as amended; and 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). Together, these laws require Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; (4) Armed Forces service medal veterans; (5) individuals with disabilities; (6) minorities and (7) women.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided wil be used only in ways that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans and individuals, and regarding necessary accommodations; (ii) first-aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.

The Company's various action oriented programs help it maintain equal employment opportunity in the workforce, reaffirming its commitment to the spirit and letter of affirmative action law.

Specific Job Applied For:
How were you referred to Crown?
If referred by a Crown Employee, who?

Please specify your race: (Check all that apply)
American Indian or Alaskan Native

(A person having origins in any of the original peoples of North, South & Central America who maintains tribal affiliation)

Asian

(A person having origins in any of the original peoples of Far East, Southeast Asia, or the Indian Subcontinent)

Black or African American

(A person having origins in any of the racial groups of Africa)

Native Hawaiian or Other Pacific Islander

(A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands)

White

(A person having origins in any of the original peoples of Europe, North Africa, or the Middle East)

I Choose Not to Disclose


Please indicate your Veteran Status:

If you believe you belong to any of the categories of protected veterans listed below, 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.
I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED BELOW
I AM NOT A PROTECTED VETERAN
I choose not to disclose.

PROTECTED VETERAN CLASSIFICATIONS:

  • A "DISABLED VETERAN" is one of the following:
    • 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 pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • 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.
Protected veterans may have additional rights under USERRA- the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-USA-DOL.

Voluntary Self-Identification of Disability

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 have ever had a disability. Completing this section is voluntary, but we hope that you will choose to answer. 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.

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 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


Please check one of the boxes below:

YES, I HAVE A DISABILITY (or previously had a disability)
NO, I DO NOT HAVE A DISABILITY.
I DO NOT WISH TO ANSWER.

Federal law requires employers to provide reasonable accommodations 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 accommodations include making changes to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or specialized equipment.

i 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.

End of Voluntary Section

Attach your resume:
***If your submission is a Word document, please ensure the file is of .doc format.***
(.docx is not accepted!)

By typing your name in the box below, you are stating that all above information is correct and accurate to the best of your knowledge at the time of this application

If your application is to be considered further, we will contact you. Crown Laboratories sincerely appreciates your cooperation and understanding.