Hawkins Rebuilds Homes, Inc. (HRHI) prides itself on being an Equal Opportunity Employer.
We will not discriminate in employment because of sex, age, race, physical disability, religion, ethnicity,
 mental disability, marital status, ancestry, or place of origin.
All information obtained within this application will be held in strict confidence, subject to applicable law.
Please complete all applicable sections and sign the last page.
P L E A S E   P R I N T   C L E A R L Y - If we can't read it, we won't know what you can do!

1		Date:	Home Phone:
		Name:	Mobile Phone:
		Address:	Pager #:
		City, ST, Zip	S/S #:
		Email Address:	Date of Birth:
		Emergency Contact Information:
		Are you legally entitled to work in USA?	Proof will be required upon hire
		Position(s) applying for:
		Date you are available to start:	Wage or salary desired:
		Ever worked for HRH / HHOOT or HRHI before?	If yes, when and where?

2		EDUCATIONAL & EXPERIENCE BACKGROUND
		HRHI has a company policy stating a minimum educational level of Grade 12 or equivalent for all positions but do make exceptions for specialty workers.
		Highest level of education completed:
		Name of educational institute:
		Your Specialty: ¨ Carpenter  ¨ Plumber  ¨ Electrician  ¨ Roofing  ¨ Gutters  ¨ Siding  ¨ Painter ¨ Concrete (foundations)  ¨ Yards/Lawns  ¨  Heating/Air ¨ Carpet  ¨ Doors & Windows  ¨ Dry Wall ¨ Masonry (chimney repair & brick layer)  ¨ Construction Cleanup  ¨ Other (please list)
		What machines or equipment have you operated which relate to the position for which you have applied?
		Are there any skills, experience, or other qualifications which you feel would assist you in performing the duties of the position for which you have applied?
		What type of professional license do you have, if any?

3a		List below your last two employer's or companies that you worked for/with, starting with the most recent.
		Employer’s/Companies Name:	Commencement Date:		Departure Date:
		Reason for Departure:
		Supervisor’s Name:		Telephone: (            )
		Position(s) Held:
		Duties:
		May we contact this employer? o Yes  o No  (If no, state brief reason):

3b		Employer’s/Companies Name:	Commencement Date:		Departure Date:
		Reason for Departure:
		Supervisor’s Name:		Telephone: (            )
		Position(s) Held:
		Duties:
		May we contact this employer? o Yes  o No  (If no, state brief reason):

4		If you are applying for a position that requires driving, please complete this section:
		Do you have a valid driver’s license?	License #:	State:
		Do you have reliable transportation to and from the job site?
		What type of vehicle do you have?
		Note: If you are selected for an interview, you may be required to present a copy of your driving record that is not more than 4 weeks old. After being hired, a copy of this driving record will be placed into your personnel file and an annual update will be required.

5		False information given or implied on the application is grounds for immediate dismissal without further notice.
		I hereby state that all information provided is accurate and may be verified by Hawkins Rebuilds Homes, Inc. (HRHI).  I agree that I may be discharged if HRHI at any time learns of falsification or material omission in the information provided on this application form and related documents. HRHI may contact my former employer in connection with the consideration of my employment.  All references are hereby authorized to release all information which they may have relevant to my employment with them.  I hereby release HRHI, its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information or misinformation provided by such references. I understand and agree that HRHI maintains a strict; no illegal drugs, and no alcohol policy, while on the job site or anywhere else (including driving) while representing HRHI  I understand that if I am found to have illegal drugs or alcohol on HRHI's job site that it is cause for immediate termination of my employment (contract labor, etc.), and that I can pick up my last pay check at the end of the week (Friday, anytime after noon). I further agree that I will follow all Company policies, rules, procedures, and all other directions pertaining to my employment.  I understand that HRHI reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at any time.
		Please Note:  If you are hired as an "Independent Contractor", "Contract Labor" and/or a "Sub-Contractor" HRHI will supply you with IRS Form 1099-MISC at the end of each year.  HRHI does not withhold any taxes, and is not responsible for any other withholding taxes, insurance, benefits, etc.  "Independent Contractors", "Contract Labors" and/or a "Sub-Contractors" are not entitled to any employee benefits programs.
		Applicant Signature:	Date:
		NO CONSIDERATION OF EMPLOYMENT WILL BE GIVEN TO ANY APPLICANT WHO DOES NOT SIGN THE ABOVE STATEMENT.
6		DO NOT WRITE IN THIS SECTION - For HRHI's use only.
		Copyrighted © 2003-2015 by Hawkins Rebuilds Homes, Inc - All Rights Reserved 916 E Michigan St, Indianapolis, IN 46202 USA | (317) 687-0000 Voice (317) 631-0500 Fax HRHI's Form #11 (Revised 2Jul15 at 2245)