Employment Application

  • Hydro Resources

    Employment Application

    (Driver applicants must complete a Driver’s Application for Employment)

  • CERTIFICATION & RELEASE
    TO BE READ AND SIGNED BY APPLICANT
    I understand this application form is intended for use in evaluating my qualifications for employment and this application is not an offer of employment. I further understand if hired, my employment will be considered “at-will” and my employment may be terminated for any reason by me or by Hydro Resources, with or without cause or notice, and this application is not intended to constitute a contract of continued employment. I certify that the information submitted by me on this application is true and complete. I understand if any false information, misrepresentations, or omission on this application, or other written materials, and provided during any interviews will lead to the rejection of my application, or, if I am employed, discipline up to and including termination at the time such false information or omission is discovered. I understand additional testing of job-related skills and for the presence of drugs may be required prior to employment. I also understand after an offer of employment and prior to reporting for work, I may be required to submit to a medical review depending on Company policy and the needs of the position; I may be required to complete a medical history form and be examined by a medical professional designated by Hydro Resources. I further understand I may not be under the influence of drugs or alcohol during employment and if Company policy so requires, I may be required to submit to drug and/or alcohol testing at an approved testing facility. I understand that smoking is prohibited in all indoor areas of Hydro Resources facilities unless designated smoking areas have been established at a particular location in accordance with applicable state and local laws. I authorize Hydro Resources and/or its agents, including consumer reporting bureaus, to investigate and verify any of the information provided herein. I authorize my former employers, educational institutions, references and any relevant agencies to provide information to Hydro Resources about my background and experience from any liability whatsoever arising therefrom. This application will only be considered for 90 days. If you have not been hired within 90 days of filling out this application and you wish to be considered for future employment, you must complete a new application.
  • APPLICANT TO COMPLETE

    APPLICANT INSTRUCTIONS

    Individuals who need assistance with any phase of the application process should notify the person who provided the application to request reasonable support.

    1. Complete all pages
    2. Print clearly; incomplete or illegible applications will not be processed. Please note “Not Applicable or N/A” if question does not apply.
    3. Provide only requested information. Failure to do so may result in disqualification of your application.
    4. Some packets may include an EEO Self Identification Form. This information is being gathered for federal recordkeeping and/or affirmation action purposes only. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire.

    Hydro Resources is an equal opportunity employer and does not discriminate against any applicant or employee due to race, color, religion, gender, national origin, age, disability, veteran status, citizenship or any other characteristic protected by federal, state, or local laws.

  • Proof of employment eligibility will be required if hired

  • AVAILABILITY
  • *Reasonable efforts will be made to accommodate sincerely held religious beliefs.

  • ESSENTIAL JOB FUNCTIONS
  • PROFESSIONAL LICENSES & CERTIFICATES
  • REFERENCES

    Include only individuals familiar with your work ability. Don not include relatives or names of supervisors listed.

  • EDUCATION

    Check the highest grade completed

  • PREVIOUS EMPLOYERS

    PLEASE NOTE: Your application may not be considered unless every question in this section is answered. Hydro Resources will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. If needed, locate phone numbers using the Web. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.

    (In Massachusetts, an applicant may include any verified work performed on a volunteer basis.)

  • MOST RECENT EMPLOYER
  • (In Massachusetts, an applicant may include any verified work performed on a volunteer basis.)

  • PRIOR EMPLOYER
  • (In Massachusetts, an applicant may include any verified work performed on a volunteer basis.)

    PRIOR EMPLOYER
  • (In Massachusetts, an applicant may include any verified work performed on a volunteer basis.)

    MOST RECENT EMPLOYER
  • DRIVER’S LICENSE INFORMATION
  • CRIMINAL RECORD

    Have you ever been convicted of or pleaded guilty to a crime?

    Do not include convictions that were sealed, erased, annulled or expunged pursuant to a court order.

    NOTE: BEFORE ANSWERING THIS QUESTION REGARDING CRIMINAL CONVICTIONS, PLEASE REFER TO THE INSTRUCTIONS BELOW IF YOU RESIDE OR ARE APPLYING FOR A POSITION IN CALIFORNIA, CONNECTICUT, DISTRICT OF COLUMBIA, GEORGIA, HAWAII, MASSACHUSETTS, NEVADA, NEW YORK, OR WASHINGTON.

  • INSTRUCTIONS FOR ANSWERING CRIMINAL CONVICTION INQUIRY
    California Applicants

    Do not identify and misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been dismissed by a court. Do to disclose your referral to or participation in any pretrial or post-trial diversion program. Also, do not identify marijuana-related convictions entered by the court more than two (2) years ago that involve: unlawful possession of marijuana; transportation or fiving away up to 28.5 grams of marijuana, other than concentrated cannabis, or the offering to transport or give away up to 28.5 grams of marijuana, other than concentrated cannabis; possession of paraphernalia used to smoke marijuana; being in a place with knowledge that marijuana was being used; or being under the influence of marijuana.

    Connecticut Applicants

    Applicants are not required to disclose the existence of any arrest, criminal charge, or conviction, the records of which have been erased pursuant to section 46b – 146, 54 – 760, or 54 – 142a of the Connecticut General Statutes. Criminal records subject to erasure under these sections are records pertaining to a finding of delinquency or the fact that a child was a member of a family with service needs, and adjudication as a youthful offender, a criminal charge that has been dismissed or nulled (not prosecuted), a criminal charge for which the person was found not guilty, or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been erased pursuant to these sections is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath.

    District of Columbia Applicants

    Do not identify convictions that are more than ten (10) years old.

    Georgia Applicants

    Do not identify and guilty plea that was discharged by the court under Georgia’s First Offender Act.

    Hawaii Applicants

    Do not answer this question at this time. You will only have to answer this question if you receive a conditional offer of employment. At that time, you will be asked whether you have been convicted of a crime within the past ten (10) years.

    Massachusetts Applicants

    An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, an applicant for employment may answer “no record” with respect to an inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. Massachusetts applicants should not disclose information regarding first-time misdemeanor convictions for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace. Finally, Massachusetts applicants should not disclose convictions for other misdemeanors where the date of the conviction or the end of any period of incarceration was more than five years ago unless there have been subsequent convictions within those five years.

    Nevada Applicants

    Only disclose misdemeanors that result in imprisonment and all felonies

    New York Applicants

    Do not disclose information regarding any criminal proceeding that terminated in a “youthful offender adjudication”, as defined in section 720.35 of the New York Criminal Procedure Law.

    Washington Applicants

    Do not identify any conviction that is more than ten (10) years old at the time of making this application.

  • CERTIFICATION & RELEASE

    I understand that this application form is intended for use in evaluating my qualifications for employment and that this is not an offer of employment. I further understand that if hired, my employment will be considered “at-will” and my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company, and this application is not intended to constitute a contract of continued employment.

    I certify that the information submitted by me on this application is true and complete. I understand that any false information, misrepresentations or omissions on this application , on other written materials, or provided during any interviews will lead to the rejection of my application or, if I am employed, discipline up to and including termination at the time such false information or omission is discovered.

    I understand that additional testing of job-related skills and for the presence of drugs may be required prior to employment. I also understand that after an offer of employment and prior to reporting to work, I may be required to submit to a medical review and depending on Company policy and the needs of the job, I may be required to complete a medical history form and be examined by a medical professional designated by the company. I also understand that I may not be under the influence of drugs or alcohol during employment and that if Company policy requires, I may be required to submit to drug and/or alcohol testing at an approved testing facility.

    I understand that smoking is prohibited in all indoor areas of the Company’s facilities unless designated smoking areas have been established at a particular location in accordance with applicable state and local law.

    I authorize the Company and/or its agents, including consumer reporting bureaus, to investigate and verify any of the information provided by me. I authorize my former employers, educational institutions, references and any relevant agencies to provide information to the Company and/or its agents concerning my background and experience. I release the Company and all parties providing information to the Company about my background and experience from any liability whatsoever arising therefrom.

  • This application will only be considered for 90 days. If you have not been hired within 90 days of filling out this application and you wish to be considered for future employment, you must complete a new application.

    STATE SPECIFIC NOTIFICATIONS

    “Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.”

    Maryland Applicants: Please sign and acknowledge receipt of the above notice.

  • Massachusetts Applicants: “It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

    Rhode Island Applicants: “the company is subject to Chapters 29-38 of Title 28 of the General Laws of Rhode Island, and is therefore covered by the state’s workers’ compensation law.

  • Fair Credit Reporting Act Candidate Notice & Disclosure

    Hydro Resources (the “Company”) will order a consumer report and/or an investigative consumer report (background check report) on you in connection with your application for employment, or if already hired, or if you already work for the Company, we may order additional background check reports on you for employment purposes without obtaining additional consent, where permissible by law. The consumer reporting agency (“Consumer Reporting Agency”) that will prepare and process the report(s) is:

    ADP Screening and Selection Services
    301 Remington Street
    Fort Collins, Colorado 80524
    Telephone 800-367-5933

    In the event that information from the report is utilized in part or in whole in making an adverse decision with regard to your potential employment or employment, before making the adverse action, we will provide you with a copy of the report and a description in writing of your rights under the law.

    You have the right to request, in writing, within a reasonable time, that we disclose the nature and scope of the information requested. Such disclosure will be made to you within 5 days of the date on which we receive the request from you or within 5 days of the time the report was first requested, whichever is the later. To receive this information or to inspect any files concerning such a report or to determine if a report has been requested, you may contact the Company or the Consumer Reporting Agency.

    The Fair Credit Reporting Act and certain state laws give you specific rights in dealing with consumer reporting agencies. You will find these rights in the attached documents.

    Please be advised that we may also obtain an investigative consumer report (background check report) on you that may include information as to your character, general reputation, personal characteristics, and mode of living. By your signature below, you hereby authorize us to order consumer and/or investigative consumer reports including, but not limited to: Social Security number validation, criminal conviction records, employment and earnings history, education, credit, licensing and certification checks, references, military service, sex offender registry, civil cases, OIG/GSA, OFAC/Patriot Act records, any sanctions list, FBI fingerprinting, and if applicable, workers’ compensation injuries, driving record, and drug testing results. The information may be obtained from private and public repositories of information, and can be disclosed to the processing agency (Consumer Reporting Agency) listed above and its agents

  • I acknowledge receipt of this Disclosure and the attached Fair Credit Reporting Act Summary of Rights.

  • GIVE A COPY WITH STATE LAW NOTICES (PG. 9), SUMMARY OF RIGHTS (PG. 10), AND RELEASE AUTHORIZATION (PG. 11) DOCUMENTS TO CANDIDATE. RETAIN A COY FOR COMPANY FILES

    For residents of, or for jobs located in California, Maine, Massachusetts, Minnesota, New Jersey, New York, Oklahoma and Washington, you may request a free copy of any background check report by checking the box below.

  • STATE LAW NOTICES:

    If you live in, or are seeking work for the Company in California, Maine, Massachusetts, New York, or Washington, note:

    CALIFORNIA

    You may view the file that the Consumer Reporting Agency has for you, and order a copy of the file, upon submitting proper identification and paying copying costs, by going to the Consumer Reporting Agency’s offices during normal business hours and on reasonable notice, or by mail. You may also ask for a file summary by telephone. The Consumer Reporting Agency can answer questions about information in your file, including any coded information. If you go in person, another person can come with you, so long as that person can show proper identification.

    MAINE.

    If you ask us, you have the right to know whether Hydro Resources ordered a background check report on you. You may request the name, address, and telephone number of the nearest office for the Consumer Reporting Agency. We will send this information to you within five business days of our receipt of your request. You have the right to ask the Consumer Reporting Agency for the report.

    MASSACHUSETTS.

    If you ask, you have the right to a copy of any background check report concerning you that Hydro Resources has ordered. You may contact the Consumer Reporting Agency for a free copy.

    NEW YORK.

    If you submit a written request, you have the right to know whether Hydro Resources ordered a background check on you from the Consumer Reporting Agency. You may inspect and order a copy by contacting the Consumer Reporting Agency. If you have previously been convicted of one or more criminal offenses and are denied employment, you may request that Hydro Resources provide a written statement setting for the reasons for such denial. Hydro Resources must provide the written statement within thirty (30) days of your request.

    WASHINGTON STATE
    .

    You have the right, upon written request made within a reasonable time frame after your receipt of this disclosure, to receive from Hydro Resources a complete and accurate disclosure of the nature and scope of any “investigative” summary of your rights and remedies under the Washington Fair Credit Reporting Act. If Hydro Resources obtains information bearing on your credit worthiness, credit standing, or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

  • Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, DC 20580

    A Summary of Your Rights Under the Fair Credit Reporting Act

    The Federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington DC 20580.

    • You must be told if information in your file has been used against you.Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address and phone number of the agency that provided the information
    • You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
      1. A person has taken adverse action against your because of information in your credit report;
      2. You are the victim of identity theft and place a fraud alert in your file;
      3. Your file contains inaccurate information as a result of fraud;
      4. You are on public assistance;
      5. You are unemployed but expect to apply for employment within 60 days.
      In addition, by September 2005, all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information
    • You have the right to dispute incomplete or inaccurate information.. If you identify information in your file that is incomplete or inaccurate and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures
    • Consumer reporting agencies may not report out dated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
    • Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.
    • You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer.
  • Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit
    • You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.
    • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
    • Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit

    States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are:

    TYPE OF BUSINESS CONTACT
    Consumer reporting agencies, creditors and other not listed below Federal Trade Commission Consumer Response Center – FCRA Washington, DC 20580 877-382-4357
    National banks, federal branches/agencies of foreign banks (word “National” or initials “N.A.” appear in or after bank’s name) Office of the Comptroller of the Currency Compliance Management Mail Stop 6-6 Washington, DC 20219 800-613-6743
    Federal Reserve System member banks (except national banks and federal branches/agencies of foreign banks) Federal Reserve Board Division of Consumer & Community Affairs Washington, DC 20551 202-452-3693
    Savings associations and federally chartered savings banks (word “Federal” or initials “F.S.B.” appear in federal institution’s name) Office of Thrift Supervision Consumer Complaints Washington, DC 20552 800-842-6929
    Federal Credit Unions (words “Federal Credit Union” appear in institution’s name) National Credit Union Administration 1775 Duke Street Alexandria, VA 22314 703-519-4600
    State-chartered banks that are not members of the Federal Reserve System Federal Deposit Insurance Corporation Consumer Response Center 2345 Grand Ave., Ste. 100 Kansas City, Missouri 64108- 2638 877-275-3342
    Air, surfac3e, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Department of Transportation Office of Financial Management Washington, DC 20590 202-366-1306
    Activities subject to the Packers and Stockyards Act of 1921 Department of Agriculture Office of Deputy AdministratorGIPSA Washington, DC 20250 202-720-7051
  • Candidate Release Authorization
    1. In connection with my application for employment or continued employment at Hydro Resources (the Company), I understand that a consumer report and/or an investigative consumer report will be ordered that may include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance and experience, along with reasons for termination of past employment. I understand that to the extent permitted by applicable law and as directed by company policy and consistent with the job described, Hydro Resources may be requesting information from public and private sources about me, including but not limited to: Social Security Number validation, criminal conviction records, employment and earnings history, education, credit, licensing and certification checks, references, military service, sex offender registry, civil cases, OIG/GSA, OFA/Patriot Act records, any sanctions list, FBI fingerprinting , and if applicable, worker’s compensation injuries, driving record, drug testing results. If company policy requires and to the extent permitted by law, I am willing to submit to alcohol and/or drug testing to detect the use of alcohol or drugs prior to and during employment.
    2. Medical and workers’ compensation information will only be requested in compliance with the federal Americans with Disabilities Act (ADA) and/or any other applicable state or local laws and only after a conditional job offer is made.
    3. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies. In the event that an agency or record source requires an alternative release form or additional identifying characteristics in order to release the requested information, I agree to provide the additional information and sign any additional release authorizations, if so requested by Hydro Resources.
    4. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer form a Consumer Reporting Agency. If so, I will be notified and given the name and address of the agency or the source that provided the information. Applicants in Massachusetts, Minnesota, Oklahoma, New York, Maine, Washington, New Jersey and California: if you want a free copy of the report(s) ordered, check this box  . The Report(s) will be sent to you by the Consumer Reporting Agency listed here: ADP Screening and Selection Services, 301 Remington Street, Fort Collins, Colorado 80524.. See attached Candidate Notice and Disclosure Form for other notices.
    5. . I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference, insurance company or other applicable record source by Hydro Resources or its agent, to furnish the information described in Section I.
    6. If applicable, I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer to Hydro Resources. This release is in accordance with DOT Regulation 49 CFR Part 40, Section 40.25. I understand that information to be released by my previous employer is limited to the following DOT-regulated items: alcohol tests with a result of 0.04 or higher, verified positive drug tests, refusals to be tested, other violations of DOT agency drug and alcohol testing regulations, information obtained from previous employers of a drug and alcohol rule violation and any documentation of completion of the return-to-duty process following a rule violation.

    The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. I understand that this information is confidential and will not be used for any other purposes. I hereby release the employer, its agents, officials, representatives or assigned agencies, including officers, employees or related personnel, both individually and collectively and all persons, agencies, and entities providing information or reports about me from any and all liability for damages of whatever kind which may at any time result to me, my heirs, family or associates arising out of the requests for or release of any of the above mentioned information or reports.

  • I CERTIFY THAT THE INFORMATION THAT I PROVIDED ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT FALSE INFORMATION, MISREPRESENTATIONS AND OMISSIONS MAY DISQUALIFY ME FROM CONSIDERATION FOR EMPLOYMENT, OR, IF I AM HIRED OR ALREADY WORK FOR HYDRO RESOURCES, THAT I MAY BE DISCIPLINED, UP TO AND INCLUDING TERMINATION.

  • If required, Notarize here. When using an embossed seal, Please shad with a pencil before faxing.

  • Provide a copy of this page to the candidate and retain a copy for company files.
    THIS PAGE CONTAINS SENSITIVE INFORMATION. KEEP ONLY IN SECURE FILES SEPARATE FROM PERSONNEL RECORDS.

  • This Organization
    Participates in E-Verify

  • This employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization.

    IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact DHS and/or the SSA before taking adverse action against you, including terminating your employment.

    Employers may not use E-Verify to pre-screen job applicants and may not limit or influence the choice of documents you present for use on the Form I-9.

  • To determine whether Form I-9 documentation is valid, this employer uses E-Verify’s photo matching tool to match the photograph appearing on some permanent resident cards, employment authorization cards, and U.S. passports with the official U.S. government photograph. E-Verify also checks data from driver’s licenses and identification cards issued by some states.

    If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the employment eligibility verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 800-255-7688, 800-237-2515 (TDD) or at www.justice.gov/crt/osc.

  • E-Verify Works for Everyone

    For more information on E-Verify, please contact DHS:

    888-897-7781

    www.dhs.gov/E-Verify

  • N O T I C E:
    Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.

    E-VERIFY IS A SERVICE OF DHS AND SSA

    The E-Verify logo and mark are registered trademarks of Department of Homeland Security. Commercial sale of this poster is strictly prohibited.