Employment Application We Are an Equal Opportunity Employer Personal Information Name* Phone* Email* Address #1* Address #2 City* State* Zip Code* Referred By Employment Desired Position* Date You Can Start* Salary Desired* Are you employed now?YesNo Are you legally authorized to work in the U.S.?YesNo Ever applied to A.C.S. before?YesNo When? Where? Education History Name & Location of High School Years Attended Did you graduate? Subjects Studied Name & Location of College Years Attended Did you graduate? Subjects Studied Name & Location of Trade School Years Attended Did you graduate? Subjects Studied General Information Do you have a valid drivers license?YesNo Do you have a commercial license?YesNo Equipment you can operate Special Training Special Skills Former Employers (List below last four employers, starting with last one first.) Employer #1 From: To: Name & Address of Employer Phone Number Position Reason for leaving Employer #2 From: To: Name & Address of Employer Phone Number Position Reason for leaving Employer #3 From: To: Name & Address of Employer Phone Number Position Reason for leaving Employer #4 From: To: Name & Address of Employer Phone Number Position Reason for leaving References (Give below the names of three persons not related to you, whom you have known at least one year.) Reference #1 Name* Phone Number* Business* Years Known* Reference #2 Name* Phone Number* Business* Years Known* Reference #3 Name* Phone Number* Business* Years Known* Authorization "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. 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 and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make may agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) or other relevant federal and state laws." Date* Signature*
