Updated 9/6/2021 AMTEX Application

An Equal Opportunity Employer We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Name*

First nameMiddle initialLast name

Address*

City*

State*

Zip*

Last 4 digits of social security #*

Are you at least 18?*

YesNo

Day phone*

Cell phone*

Email address*

example@example.com

Are you authorized to work in the United States?*

YesNo

Position desired*

Starting salary expected*

How were you referred to us?*

Date available for employment*

Date

Have you previously been employed by this company?*

YesNo

If yes, When?

If yes, provide your Badge #

Are you a Veteran of the United States Military service?*

YesNo

Have you ever been involuntarily terminated?*

YesNo

If Yes, please explain.

Have you been convicted of, or have you pleaded guilty or no contest to, a felony offense?*

If Yes, Please Explain

Vocational/Technical School Name & Address

Date Attended

Did You Graduate?

Area of Study

Grade | GPA

College/University School Name & Address

Dates Attended

Did You Graduate?

Degree | Major

Grade | GPA

High School Name & Address*

Dates Attended*

Did You Graduate?*

Degree | Major

Grade | GPA

Other Courses, Training, Research, Job Related Skills or Related *

Other Courses, Training, Research, Job Related Skills (Continued)

Professional Registrations Or Certifications*

Professional Registrations or Certifications (Continued)

We Are An Equal Opportunity Employer. In Order For You To Be Considered For Employment, This Information Sheet Must Be Filled Out In Its Entirety.

Previous employer*

Phone*

Address*

Supervisor*

Job title*

Salary*

Employment Start Date*

Employment End Date*

Reason for leaving*

Description of duties and responsibilities*

Previous employer*

Phone*

Address*

Supervisor*

Job title*

Salary*

Employment Start Date*

Employment End Date*

Reason for leaving*

Description of duties and responsibilities*

Previous employer

Phone

Address

Supervisor

Job title

Salary

Employment Start Date

Employment End Date

Reason for leaving

Description of duties and responsibilities

Name*

Relationship*

Phone Number*

Please enter a valid phone number.

Name

Relationship

Phone Number

Please enter a valid phone number.

Name

Relationship

Phone Number

Please enter a valid phone number.

Name*

Address & Telephone # *

Occupation *

Name*

Address & Telephone # *

Occupation *

Name

Address & Telephone #

Occupation

I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment, and I understand that any wrong or incomplete information on the form may disqualify me for further consideration for employment or, if discovered after I am hired, may be grounds for my immediate dismissal. I understand that all such information is subject to verification by AMTEX, and hereby give my consent to AMTEX to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo any type of drug and/or alcohol testing that AMTEX may require at any time. Finally, I understand that submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and either I or AMTEX may terminate my employment at any time, with or without notice or reason."

The EEOC requires employers to keep solicited job applications for at least one year it is best to keep them at least 4 years, in order to exhaust all possible statutes of limitations for various employment law causes of action, and the application for the successful candidate for at least 7 years; if EEOC investigates and finds that applications have not been kept, that is not only a recordkeeping violation, but also potential evidence of intent to discriminate.

***** I AFFIRM THAT I HAVE RECEIVED THE JOB DESCRIPTION FOR THE ABOVE-MENTIONED POSITION DESIRED. *****

Signature*

Date*

Date

We Are An Equal Opportunity Employer. In Order For You To Be Considered For Employment, This Information Sheet Must Be Filled Out In Its Entirety.

BASIC INFORMATION SHEET

GENERAL INFORMATION

SCHOOL

OTHER

EMPLOYMENT HISTORY

EMERGENCY CONTACTS

REFERENCES