Application Form Application American Services Technology, Inc. Application For Employment Application Information The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, gender, religion or national origin. The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age but less than 70. TITLE I employment provisions of the AMERICAN WITH DISABILITIES ACT OF 1980 prohibits discrimination against qualified individuals with disabilities in job application procedures.Applicant Name First Middle Last Applicant Email* Applicant Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at above address?Applicant PhoneApplicant Previous Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you legally eligible for work in the United States?YesNoAre you 18 years or older?YesNoPosition(s) applied for Add another position by clicking the plus icon to the right of the field.Would you prefer full time workFull TimePart TimeTemporaryDate Available Date Format: MM slash DD slash YYYY Have you worked with us before?YesNoIf yes, when:List any friends of relative working for us:Please list any additional information that relates to your ability to perform the job for which you have applied, such as special training, machine operations, hobbies, languages, etcU.S. armed forces?YesNoIf yes, branch:Rank at dischargeHave you been convicted of a felony within the past 7 year?YesNoIf yes, please explain:(Conviction will not necessarily disqualify applicant for employment)Accident or emergency notificationEmergency Contact NameEmergency Contact PhoneEmergency Contact AddressEmergency Contact RelationshipAmerican Services Technology, Inc. Application For Employment Educational Background School Name & City Years Attended Graduated Course or Major Grammar School Name(s) Grammar school years attendedGrammar school graduatedYesNoGrammar school course or major Highschool Name(s) Highschool years attendedHighschool graduatedYesNoHighschool course or major College Name(s) College years attendedCollege graduatedYesNoCollege course or major Trade, Business, or Correspondence Name(s) TBC years attendedTBC graduatedYesNoTBC course or major Describe Any Other Experience, Skills Or Qualifications Which You Think Could Be Helpful In Work For The CompanyPersonal References (Excluding Former Employers or Relatives)Reference Name #1Business Reference #1Address Reference #1Phone Reference #1City Reference #1State Reference #1Zip Reference #1Years Acquainted - Reference #1Reference Name #2Business Reference #2Address Reference #2Phone Reference #2City Reference #2State Reference #2Zip Reference #2Years Acquainted - Reference #2Reference Name #3Business Reference #3Address Reference #3Phone Reference #3City Reference #3State Reference #3Zip Reference #3Years Acquainted - Reference #3American Services Technology, Inc. Application For Employment EMPLOYMENT HISTORY (list below last three employers starting with last one first Please submit resume with applicationEmployer Name #1Dates EmployeedEmployment Address #1Employment From Date - Employer #1 Date Format: MM slash DD slash YYYY Employment To Date - Employer #1 Date Format: MM slash DD slash YYYY Employer #1 Telephone Number(s)Hourly Rate / SalaryEmployer #1 - Job TitleEmployer #1 - SupervisorEmployer #1 - Hourly Rate / SalaryEmployer #1 - Reason for leavingEmployer #1 - DutiesEmployer #2 NameDates EmployeedEmployer #2 AddressEmployment #2 From Date Date Format: MM slash DD slash YYYY Employment #2 To Date Date Format: MM slash DD slash YYYY Employer #2 Telephone Number(s)Hourly Rate / SalaryEmployer #2 Job TitleEmployer #2 SupervisorEmployer #2 Hourly Rate / SalaryEmployer #2 Reason for leavingEmployer #2 DutiesEmployer #3 NameDates EmployeedEmployer #3 AddressEmployer #3 From Date Date Format: MM slash DD slash YYYY Employer #3 To Date Date Format: MM slash DD slash YYYY Employer #3 Telephone Number(s)Hourly Rate / SalaryEmployer #3 Job TitleEmployer #3 SupervisorEmployer #3 Hourly Rate / SalaryEmployer #3 Reason for leavingEmployer #3 DutiesEmployer #4 Employer NameDates EmployeedEmployer #4 AddressEmployer #4 From Date Date Format: MM slash DD slash YYYY Employer #4 To Date Date Format: MM slash DD slash YYYY Employer #4 Telephone Number(s)Hourly Rate / SalaryEmployer #4 Job TitleEmployer #4 SupervisorEmployer #4 Hourly Rate / SalaryEmployer #4 Reason for leavingEmployer #4 DutiesAre You Employed Now?YesNoDoes Your Present Employer Know Of Your Plans To Change Employment?YesNoMay We Contact The Employers List Above?YesNoIf No, Indicate Which One(s) You Do Not Wish Us To ContactI Authorize Investigation Of All Statements Contained In This Application. I Understand That Misrepresentation Oo Omission Of Facts Called For Is Cause For Dismissal. Further, I Understand And Agree Thats My Employment Is For No Definite Period And May, Regardless Of The Date Of Payment Of My Wages And Salary, Be Terminated At Any Time. Date Date Format: MM slash DD slash YYYY SignatureEnter your name to sign your application.Upload Resume or Other FilesCAPTCHA
