Online Application Position Applying for * Welder/Fabricator Custom Fabrication Estimator Assembly - Construction CAD Programmer Tube Laser Operator CDL Delivery Driver - Class A Waterjet Operator Bridge Mill Operator CNC Lathe Operator Pressbrake Laser Operator Horizontal Mill Operator Vertical Mill Operator Full Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you legally eligible for employment in the United States? * Yes No Are you at least 18 years of age? * Yes No Have you ever been employed with us before? * Yes No Are you available to work? * Full-time Part-time When will you be available for employment? MM DD YYYY Education High School Name of School Address of School Address 1 Address 2 City State/Province Zip/Postal Code Country Years Completed Graduated Yes No Enrolled Undergraduate College Name of College Address of College Course of Study Years Completed Graduated Yes No Enrolled Graduate Professional Name of School Address of School Course of Study Years Completed Graduated Yes No Enrolled Other (Specify) Name of School Address of School Course of Study Years Completed Graduated Yes No Enrolled Employment Experience Employer 1 * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Job Title/Supervisor * Reason for Leaving Dates Employed From MM DD YYYY To MM DD YYYY Hourly Rate/Salary Starting Final Work Performed Employer 2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Job Title/Supervisor Reason for Leaving Dates Employed From MM DD YYYY To MM DD YYYY Hourly Rate/Salary Starting Final Work Performed Employer 3 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Job Title/Supervisor Reason for Leaving Dates Employed From MM DD YYYY To MM DD YYYY Hourly Rate/Salary Starting Final Work Performed May we contact all employers listed? * Yes No If no, please explain: Skills & Qualifications Describe any specialized training, apprenticeship, skills, and extra-curricular activities that would benefit your employement opportunity with American Custom Metal Fabricating, Inc. Describe any job-related training or specialized skills that would benefit your employment opportunity with American Custom Metal Fabricating, Inc. Additional Information Have you ever been convicted of a crime, misdemeanor or any unlawful activity, other than a minor traffic violation? * Yes No If yes, explain and list each conviction(s), nature of offense(s) leading to conviction(s), date(s) of occurrence and sentence(s) imposed. (A conviction does not automatically bar you from employment.) Complete This Section If Position Will Require Driving Do you have a Driver's License? Yes No Driver's License Number State of Issue Expiration Date MM DD YYYY Choose One: Operator Commercial (CDL) Occupational Have you had any accidents during the past three years? Yes No If yes, how many? Have you had any moving violations during the past three years? Yes No If yes, how many? References Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Reference Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Reference Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Type of Reference Release of Information Authorization I hereby affirm the information given by me on this application for employment is complete and accurate. I understand any falsification or omission will be immediate grounds for dismissal. I authorize a thorough investigation to be made in connection with this application concerning my character, general reputation, personal characteristics, employment and educational background, any criminal record, and mode of living, whichever may be applicable. Where applicable, the company will comply with the Fair Credit Reporting Act. I hereby authorize the release of documents and personal interviews with third parties, such as prior employers, family members, business associates, financial sources, friends, neighbors, or others with whom I am acquainted. I further understand I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of this investigation. It is understood, as a condition of initial or continued employment, I agree to submit to such lawful examinations, medical, substance abuse, or other, as may be required by the company. The company will pay the reasonable cost of any such examination which may be required. If I am hired, I agree my employment and compensation can be terminated with or without cause and without notice, at any time, at the option of this company or myself. I understand no manager or other representative other than a vice-president, and in writing, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I have read and affirm as my own the above statements. Signature * Date * MM DD YYYY American Custom Metal Fabricating, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you your opportunity for employment with American Custom Metal Fabricating, Inc. depends solely on your qualifications. Applicant Information The following information will only be used to process a background criminal check if you are selected as a final candidate for this position. The information is voluntary and there will be no adverse consequences for not responding; however, it will expedite this step of the pre-employment process. The information listed below will be maintained confidentially and kept separate from your application. It will not be a consideration for employment. Position Applied for Welder/Fabricator Custom Fabrication Estimator Assembly - Construction CAD Programmer Tube Laser Operator CDL Delivery Driver - Class A Waterjet Operator Bridge Mill Operator CNC Lathe Operator Pressbrake Laser Operator Horizontal Mill Operator Vertical Mill Operator Referral Source Advertisement Friend Relative Walk-In Employment Agency Other Full Name (Last, First, M.I.) Any Previous AKA or Alias Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Previous Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Social Security Number Affirmative Action/Equal Employment Opportunity Data The following information will be used only for research and reporting purposes for American Custom Metal Fabricating, Inc. in accordance with applicable laws and regulations. This information is voluntary and there will be no adverse consequences for not responding. This information is confidential and is kept separate from this application. It will not be a consideration for employment. Gender Male Female Age Under 40 40 or Over Ethnic Origin American Indian/Alaskan Native Black/African American White/Caucasian/European/North African/Middle eastern or Indian Subcontinent Hispanic/Chicano/Puerto Rican/Mexican/Cuban/Central or South American Asian American/Pacifica Islander/Far eastern or Southeastern Asian Veteran Status Non Veteran Veteran Newly Separated Veteran Special Disabled Veteran (Disability 30% or greater) Vietnam Era Veteran Other Protected Veteran If yes, what branch? Specialty Date Entered MM DD YYYY Discharge Date MM DD YYYY Discharge Type Disability The Americans with Disabilities Act (ADA) defines an individual with a disability as “one who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or who is regarded as having such an impairment.” Based on this definition, are you an individual with a disability? Yes No Thank you! Your application has been submitted.
