Optional Affirmative Action Section
Government Agencies require reports on status of applicants. This data is for analysis
and affirmative action only. Submission is voluntary. Failure to supply this information
will not jeopardize or adversely affect any consideration you may receive for employment,
or alter advancement in employment.
Sex
Ethnicity
- A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture of origin, regardless of race.
Race
- A person having origins in any of the original peoples of North and South America
(including Central America), and who maintains tribal affiliation or community attachment.
- A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
- A person having origins in any of the Black racial groups of Africa.
- A person having origins in any of the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands.
- A person having origins in any of the original peoples of Europe, the Middle East,
or North Africa.
- All persons who identify with more than one of the above five races.
Veteran
Vietnam Era Veteran; Recently
Separated Veteran (during the last three year period beginning on the
date of such veteran's discharge or release from active duty;
Other Covered
Veteran (Any veteran who served on active duty during a war or campaign
for which a badge has been awarded). No Yes
Date you can start
[Set to Now]
Salary Desired
Are you employed now?
If so, may we inquire of your present employer?
How were you referred to Amada?
Have you ever applied to an Amada Group Company before?
If yes, please indicate: When
[Set to Now] and where
Result
Reason for leaving:
Education
Trade, Business or Correspondence School(s)
Former Employers
Unemployment History
Please account for any time over one month not employed in the last 10 years
Miscellaneous
Special study or research work:
Special training:
Special skills:
Do you have any commitments to any other entity, business, or person that might
affect your employment with Amada?
If yes, explain fully:
Performance of job-related functions
Are you able to perform the essential functions of the job for which you are applying,
with or without reasonable accommodation? (If you do not know the essential functions
of the job for which you are applying, please ask Human Resources)
Are you able to meet the attendance requirements of the job for which you are applying?
If no, describe the attendance requirements you cannot meet:
Criminal Matters
Have you been convicted of a felony or misdemeanor in the last seven (7) years?
Please note: Do not answer "yes" to this question if (i) your arrest or detention
did not result in a conviction, or if your conviction was annulled, expunged, purged
or sealed; (ii) you were referred to or participated in a pretrial or post trial
diversion program; (iii) it was an offence that was finally settled in juvenile
court or referred to the youth authority; or (iv) it was marijuana-related conviction
that is more than two (2) years old. Conviction will not necessarily be a bar to
employment. Each instance and explanation will be considered in relation to the
position for which you are applying.
If yes, please explain:
Professional References
Declarations
Important: Please read carefully and initial each paragraph
"I declare that the facts contained in this application or any resume or other documentation
submitted are true and complete to the best of my knowledge. I understand that any
false information or significant omissions will disqualify me from further consideration
for employment, and may result in my dismissal from employment if discovered at
a later date."
"I authorize the company to contact and obtain information from all references,
employers and educational institutions, and to otherwise verify the accuracy of
the information contained in this application, and I authorize the release of this
information"
"I understand that any offer of employment may be conditioned upon the satisfactory
results of a background investigation, a physical examination and my passing a drug/alcohol
screening"
"I understand that, if hired, I will be required to provide proof of identity and
legal work authorization"
"I understand that, if hired, I may not hold other employment or engage in other
activities that create a conflict of interest with my position in the company"
"If I become employed, and in consideration of my employment, I agree to comply
with the rules, regulations, policies and procedures of the company."
Agreement for at-will employment
"If I become employed, and in consideration of my employment, I agree that my employment
will be at-will, and may be terminated with or without cause, and with or without
advance notice, at any time at the option of myself or the company. Only the president
of the company has the authority to enter into an employment agreement for a specified
period of time or for termination only for cause, and any such agreement must bi
in writing and signed by the president of the company. I understand and acknowledge
that this constitutes the entire agreement between me and the company regarding
the term of my employment and supersedes any other oral or written agreements."
Signature:
Date:
[Set to Now]