Employment Application V3 Step 1 of 5 20% Position Applying For(Required) Desired Wage Date You Can Start(Required) MM slash DD slash YYYY Personal InformationName(Required) First Last Email Address(Required) Address(Required) Street Address Address Line 2 City State ZIP / Postal Code Social Security Number(Required) Home Phone(Required)Message PhoneWork PhoneAre you 18 years or older?(Required) Yes No Are you currently employed?(Required) Yes No May we contact you at work?(Required) Yes No What is the best time to call at home? Hours : Minutes AM PM AM/PM What is the best time to call at work? Hours : Minutes AM PM AM/PM Who referred you to API/AMS?(Required)Employment AgencyNewspaperFriendEmployment OfficeWalkinAPI/AMS EmployeeCraigslistindeed.comOtherEducationLast Level of Education Completed (high school, GED, some college, degree, etc.)(Required) List all schools attended beyond high schoolSchoolCredits CompletedTypes of Degree EarnedCourse of Study Add RemoveList any school course or vocational training, licenses, certifications, or other qualifications that bear on your suitability for this position: Add Remove Employment HistoryPlease complete this section even if you attach a resume. List your work experience, most recent first.Most Recent or Current EmployerPosition DetailsEmployerJob TitleImmediate Supervisor + Title Add RemoveEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneMay we contact for reference? Yes No Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Number of Hours per WeekDescribition of DutiesReason for Leaving Previous EmployerPosition DetailsEmployerJob TitleImmediate Supervisor + Title Add RemoveEmployer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneMay we contact for reference? Yes No Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Number of Hours per WeekDescribition of DutiesReason for Leaving ResumeAccepted file types: pdf, doc, docx, rtf, txt, Max. file size: 16 MB.You may attach your resume to this application as a PDF or Word document. AAP Survey InformationWe are compiling information to assist us in complying with our Affirmative Action Program goals, and are requesting you to complete this survey.Will you participate in the survey?(Required) Yes No Mark one of the following cateogories for gender(Required) Male Female Mark one of the following categories for ethnicity(Required) Hispanic Not Hispanic Mark one of the following categories for ethnicity(Required) Two or More Races (Non-Hispanic) American Indian or Alaska Native (Only) Native Hawaiian or other Pacific Islander (Only) Asian (Only) Black or African American (Only) White (Only) Digital Signature(Required) By typing your complete name in this box, you are digitally signing this EOE survey.Date(Required) MM slash DD slash YYYY Voluntary Self-Identification of DisabilityWhy are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.1 To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis {MS) Missing limbs or partially missing limbs Post-traumatic stress disorder {PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)Please check one box for Voluntary Self-Identification of Disability(Required) Yes, I have a disability (or previously had a disability) No, I don't have a disability I don't wish to answer Your Name(Required) Today's Date(Required) MM slash DD slash YYYY Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Footnotes 1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete. EO 11246 and VIETNAM ERA VETERANS READJUSTMENT ASSISTANCE ACT (VEVRAA)VOLUNTARY SURVEY American Precision Industries is a government contractor subject to Executive Order 11246 and the Vietnam Era Veterans Readjustment Assistance Act (VEVAA), which requires affirmative action to employ and advance in employment qualified individuals without regard to race, color, national origin, religion, or veteran status. We are compiling information to assist us in complying with our Affirmative Action Program goals, and are requesting you to complete this survey. Submission of this information is completely voluntary. Information provided will be kept confidential and used only in ways consistent with Executive Order 11246, VEVAA and government reporting requirements. Refusal to provide information will not subject you to any adverse employment decision. Completion of this portion is required regardless of participation in the survey.Name(Required) First Last Position Applied For(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code VEVRAA Survey Participation(Required) I will participate in the survey I will not participate in the survey Select one of the following categories for gender(Required) Male Female Select one of the following categories for ethnicity(Required) Hispanic Not Hispanic Select one of the following categories for race(Required) Two or More Races (Non-Hispanic) Asian (Only) American Indian or Alaska Native (Only) Black or African American (Only) Native Hawaiian or other Pacific Islander (Only) White (Only) Please mark one in addition to the selection above. If you are more than one race please mark the "Two or More Races" boxMARK ONE OF THE FOLLOWING CATEGORIES FOR VETERAN STATUS(Required) I am a Protected Veteran I am not a Protected Veteran You are a "protected veteran" under VEVRAA if you belong to one of the veterans categories described below: Disabled Veteran: Veteran who served on active duty in the U.S. military and is entitled to disability compensation (or who but for the receipt of military retired pay would be entitled to disability compensation) under laws administered by the Secretary of Veterans Affairs, or was discharged or released from active duty because of a service-connected disability. Active Duty Wartime or Campaign Badge Veteran: A veteran who served on active duty in the U.S. military during a war, or in a campaign or expedition for which a campaign badge was authorized under the laws administered by the Department of Defense. Recently Separated Veteran: A veteran separated during the three-year period beginning on the date of the veteran's discharge or release from active duty in the U.S. military. Armed Forces Service Medal Veteran A veteran who, while serving on active duty in the U.S. military, participated in a U.S. military operation that received an Armed Forces service medal. Δ
