Application for Employment

Applicant Information

Legal First Name *

Legal Last Name *

Middle Initial

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Email Address *

Primary Phone # *

Alternate Phone #

Do you have a valid Driver's License? *

Yes
No

Are you legally authorized to work in the United States? *

Yes
No

Do you require visa/immigration sponsorship now or in the future to continue working in the United States? *

Yes
No

Please provide details *

Employment Desired

Position Applying For *

Are you available to work weekends and/or holidays? *

Yes
No

Hourly rate of pay or annual salary desired: *

Full-time or Part-time? *

Full-time
Part-time

Have you ever been convicted of or pled guilty or no contest to any crime other than a misdemeanor? *

Yes
No

Please explain giving dates and details: *

Are you currently on probation under the terms of deferred adjudication? *

Yes
No

Please explain giving dates and details: *

Education & Training

Special Skills

Certifications (Include certification # and expiration dates):

Professional Licenses (Include issuing states, if applicable):

Professional Society Affiliations:

Any other experience, training, qualifications or skills which will enhance your application:

Professional References

Reference #1

First Name *

Phone # *

Time Known *

Last Name *

Relationship *

Email

Reference #2

First Name *

Phone # *

Time Known *

Last Name *

Relationship *

Email

Reference #3

First Name *

Phone # *

Time Known *

Last Name *

Relationship *

Email

Employment History

Please list below all previous employers starting with your present or most recent position (last 10 years is sufficient).

Name of Company *

Address *

City

State / Province / Region

Start Date (Month/Year) *

End Date (Month/Year) - If current employer, please type "Current" *

Starting Rate of Pay *

Ending Rate of Pay *

- Do you have additional work experience you'd like to add? *

Yes
No

Position Held *

Phone # *

May we contact this employer? *

Yes
No

Supervisor's Name *

Summary of Duties *

Reason for Leaving *

Name of Company *

Address *

City

State / Province / Region

Start Date (Month/Year) *

End Date (Month/Year) *

Starting Rate of Pay *

Ending Rate of Pay *

-- Do you have additional work experience you'd like to add? *

Yes
No

Position Held *

Phone # *

Supervisor's Name *

Summary of Duties *

Reason for Leaving *

Name of Company *

Address *

City

State / Province / Region

Start Date (Month/Year) *

End Date (Month/Year) *

Starting Rate of Pay *

Ending Rate of Pay *

--- Do you have additional work experience you'd like to add? *

Yes
No

Position Held *

Phone # *

Supervisor's Name *

Summary of Duties *

Reason for Leaving *

Name of Company *

Address *

City

State / Province / Region

Start Date (Month/Year) *

End Date (Month/Year) *

Starting Rate of Pay *

Ending Rate of Pay *

Position Held *

Phone # *

Supervisor's Name *

Summary of Duties *

Reason for Leaving *

Resume/File Upload

Resume Upload *

Drop your files here or click here to upload

Additional File Upload (Cover Letter, Recommendations, etc.)

Drop your files here or click here to upload You can upload up to 1 files.

Application Waiver

Please read each paragraph below carefully. If there is any part of this page you do not understand, please ask for clarification before signing.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the responses to this application (including any attachments) given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize a background screening firm and/or The Company to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the background screening firm and/or The Company any and all letters, reports, and other information pertaining to my employment with them, without giving me prior notice of such disclosure. In addition, I hereby release the background screening firm and/or The Company, my current and former employers, all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that employment is contingent on my passing a pre-employment drug screen and post-offer physical examination (if a physical is relevant to the position for which I am applying). By signing this application, I voluntarily agree to submit to a pre-employment drug screen and post-offer physical examination. I understand that failure to pass either will result in withdrawal or denial of an offer for employment.

If hired, I also agree to submit a random drug testing as a condition of employment. I agree that the background screening firm and/or The Company may conduct drug screenings at its sole discretion with or without notice, with or without cause or reason. I also understand that refusal to submit to a random alcohol/drug screen will be considered a voluntary resignation of employment.

If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid Driver's License and understand that I may be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by The Company's insurance policy if required for my position.

The Company acknowledges that information obtained during the application process is personal and private in nature and agrees not to improperly use or sell the aforementioned information.

My signature below certifies that I have read and understand each paragraph above, and agree to the terms and conditions outlined.

Applicant's Signature *

Today's Date *

Newsletter Sign-Up

Yes, I'd like to subscribe to Amerapress for the latest news, updates, and event information from Amerapex Corporation. You may unsubscribe at any time.

EEO Self-Identification

If you wish to be identified, please sign below and complete the survey:

Applicant's Signature

Gender (check one):

Male
Female

Ethnicity: Are you Hispanic or Latino?

No, I am not Hispanic or Latino.
Yes, I am Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.

Race: IMPORTANT - Only complete this section if you checked "No, I am not Hispanic or Latino" in the Ethnicity section above. Please select ONE of the following:

White - Origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black or African American - Origins in any of the Black racial groups of Africa.
American Indian/Alaskan Native - Origins of the original people of North, Central and/or South America, and who maintains tribal affiliation or community attachment.
Asian - Origins of the original people of the Far East, Southeast Asia, or the Indian subcontinent including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander - Originas of the original people of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More Races - Identify with more than one of the above five races.

Veteran Status:

Yes, I am a Veteran
No, I am not a Veteran

If you have trouble completing or submitting this form, please email your resume and any other documentation to recruiting@amerapex.com.

APPLICATION FOR EMPLOYMENT

Applicant Information

Employment Desired

Education & Training

High School

College/University

Trade/Vocational School

Advanced Degree

Computer/Technology Skills: Hardware

Computer/Technology Skills: Software

Special Skills

Professional References

Reference #1

Reference #2

Reference #3

Employment History

Resume/File Upload

Application Waiver

EEO Self-Identification

AMERAPEX

Services

Resources

Contact Us