(NOTE: If hired, you will be required to perform work as required by the Company.)
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Provide the names of at least three persons not related to you, preferably previous supervisors.
Hawaii Petroleum, Inc. is a government contractor and as such is required by law to collect data on ethnicity, gender, veteran status. This data will only be used for Affirmative Action purposes and is strictly voluntary. Please check one of the categories that you feel most characterizes your gender, ethnicity and/or veteran status:
Please answer items 1-3:
Other Protected 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.
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 (61 FR 1209, 3 CFR, 1996 Comp. p159).
Recently Seperated Veteran *
Means a 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.
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:
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.
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.
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.
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. I understand that all information on this application is subject to verification and i consent that you may contact references, former employers and educational institutions listed in this application. If offered employment with any of the THE EMAU Companies-(Hawaii Petroleum, Inc., Minit Stop Holdings, LLC.), The offer of employment is contingent upon me successfully passing a pre-employment drug screen and, if necessary, confirmatory drug test, a pre-employment criminal background check, and providing a certificate of tuberculosis (TB) examination as applicable. I understand that if I do not successfully pass the pre-employment drug screen/drug test, the pre-employment criminal background check and do not provide a certificate of tuberculosis (TB) examination (if required), my conditional offer of employment with any of the EMAU companies will be rescinded. In the event i am employed by any of the EMAU companies, i agree to conform to the company’s rules and regulations, and i agree that such employment and compensation will be subject to termination, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that, if employed, the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it’s president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. All EMAU Companies are an equal opportunity employers and do not discriminate on the basis of any legally protected category. If you require any reasonable accommodation to complete the application and/or interview process, contact the human resources director at (808) 270-2852.