FOUR C’s SERVICE, INC

Advanced
MetalINC.
Works, Inc.
AMW,
APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Name:
Date:
Last
First
Middle
Social Security #:
Phone #:
Referred By:
All Names Used In The Past:
Present Address:
Street
City
State
Zip
Street
City
State
Zip
Permanent Address:
Previous Address:
Street
City
State
Zip
State Name of Any Relatives Working For .AMW, INC.:
EMPLOYMENT DESIRED:
Position:
Date You Can Start:
Expected Rate of Pay?
Are You Employed Now?
If So, May We Contact Your Present Employer?
Yes
Yes
No
No
Have You Ever Worked for this Company?
Yes
No
If Yes, When:
Have You Ever Applied to this Company?
Yes
No
If Yes, When:
Are you available to work:
Full-time:
Yes
No
Work Out of Town:
Yes
No Seasonal Work:
Yes
No
EDUCATIONAL SKILLS:
Check highest grade completed:
4
5
6
7
8
9
10
11
12
Did you graduate from High School or receive a GED or High School equivalency diploma?
Yes
Form #19 09/25/04
No
Employment Application
Name of College
Years
Major or
Specialty
Degree
Dates
Attended
Minor
Describe any specialized training, apprenticeship, skills, extra-curricular activities, professional or
vocational certificates, licences, or registrations that are relevant to the job for which you are applying:
State any additional information you feel may be helpful to us in considering your application:
Indicate any foreign languages you can speak, read and/or write: English
Fluent
Good
SPEAK
Spanish
Other
Fair
READ
WRITE
List any job-related professional or technical organizations to which you belong to:
U.S. Military or Naval Service?
Yes
No
Rank:
Citations/Awards:
List any job-related skills that you learned while in the U.S. military or Naval Service:
Drivers License Information:
State
Number
Expiration Date
Restrictions or Suspensions (respond fully if driving is required by the job for which you are applying):
Have you been convicted of a crime? (Convictions will not necessarily disqualify an applicant from
employment. Do not provide information about misdemeanor marijuana convictions more than 2 years
old).
Yes
No
If yes, please explain:
Are you able to perform the duties of the position for which you are applying, including daily attendance?
Yes
No
Form #19 09/25/04
Employment Application
FORMER EMPLOYERS
Start with your present or last job. Include any job-related military service assignments and volunteer
activities.
A) Job Title:
Phone#:
Employer:
Name
Address
Supervisor Name:
Salary (start):
City
State
Zip Code
Phone#:
(finish):
Dates (mo/yr):
To (mo/yr):
Duties:
Type of Equipment Used:
Reason for leaving:
B) Job Title:
Phone#:
Employer:
Name
Address
Supervisor Name:
Salary (start):
City
State
Zip Code
Phone#:
(finish):
Dates (mo/yr):
To (mo/yr):
Duties:
Type of Equipment Used:
Reason for leaving:
C) Job Title:
Phone#:
Employer:
Name
Address
Supervisor Name:
Salary (start):
City
State
Zip Code
Phone#:
(finish):
Dates (mo/yr):
To (mo/yr):
Duties:
Type of Equipment Used:
Reason for leaving:
REFERENCES
Name
Address
Telephone Number
Years Acquainted
1.
2.
3.
Form #19 09/25/04
Employment Application
I UNDERSTAND AND ACKNOWLEDGE THE FOLLOWING:
1. I understand that I am entitled to copies of any public records obtained directly by AMW, INC. in
connection with my application for employment. Check one:
I WAIVE
DO NOT WAIVE
MY RIGHT TO RECEIVE COPIES OF
PUBLIC RECORDS OBTAINED DIRECTLY BY AMW, INC.
2. If I am offered employment, I will, as a condition of employment, be required to submit proof of
my identity and legal right to work in the U.S.
3. I understand that, if I am employed, any false statement, misrepresentation, or omission of facts
on this application or on any supporting documents, regardless of when discovered to be false or
omitted, may result in my immediate dismissal.
4. I understand that I will be required to possess a current and valid California driver’s license if my
job requires me to drive in the course of my work.
5. I agree that, if I am offered a position, it will be offered on condition that my employment shall be
at will and for no definite period, and that my employment may be terminated at any time with or
without cause and with or without prior notice. I understand that, except for the President Of
AMW, INC., no supervisor or manager may alter or amend the above conditions. Only the
President of AMW, INC., has authority to enter into any agreement for employment for any
specified period of time or to make any agreement contrary to the foregoing.
6. I understand and agree that, if I am offered a position, it will be a conditional offer based on my
successful passing of both a drug and alcohol screen and job related medical examination.
7. I understand and agree that as a condition of my employment I may be required to undergo a
medical examination.
8. I understand and agree that as a condition of my employment, I may be required to undergo drug
testing, and any other testing to the extent permitted by applicable laws.
9. I agree that I will settle any and all previously unasserted claims, disputes, or controversies
arising out of or relating to my employment, my application or candidacy for employment, and/or
cessation of employment with AMW, INC., exclusively by final and binding arbitration before a
neutral Arbitrator (pursuant to AMW, INC., Alternative Dispute Resolution Policy). By way of
example only, such claims include claims under federal, state, and local statutory law, such as the
Fair Employment and Housing Act, Age Discrimination in Employment Act, Title VII of the
Civil Rights Act of 1964, as amended including the amendments of the Civil Rights Act of 1991,
the Americans With Disabilities Act, the law of contract and the law of tort.
10. If I am offered employment, I will, as a condition of employment, furnish proof that I am over 18
years of age.
11. I agree that, if I am offered employment, I will be required to confirm to the rules and regulations
of AMW, INC.
12. I authorize investigation of all statements contained in this application and any supporting
documents. I authorize AMW, INC., to secure information about my experience from former
employers, educational institutions, government agencies, or any references I have provided, and
for those parties to provide information concerning my experience and I hereby release all parties
from any liability arising from such investigation.
Form #19 09/25/04
Employment Application
13. I understand that no supervisor or manager may alter or amend the conditions set forth in
paragraphs one (1) through eleven (11) above. I understand that the foregoing conditions can
only be altered or amended by a written agreement signed by the President of AMW, INC.
Signature
Form #19 09/25/04
Date
Employment Application
“QUALITY & DEPENDABILITY
ADVANCED METAL WORKS, INC.
1560 "H" Street
Fresno CA 93721-1616
Main Phone: 559-237-2332 Main Fax: 559-237-1659
WITHOUT COMPROMISE”
Commercial & Industrial Sheet Metal Fabrication,
Architectural Sheet Metal, Custom Stainless Steel,
Aluminum Roof-Curbs, Radius Flashing,
Certified Welding (Mig and Tig)
Name of Job Applicant/Employee
Street Address
City, State, Zip Code
Date
Department of Motor Vehicle reports may be obtained as part of the Four C’s Service, Inc.’s
evaluation of my job application/employment. The reports may be procured by Van Beurden
Insurance Company, and may include my driving record, to assess my insurability under the
Company’s insurance coverage’s. By signing this disclosure, I hereby authorize the Company to
procure such reports about me from time to time, as it deems appropriate, to evaluate my
insurability and I give them permission to provide copies to my employer.
Signature of Applicant/Employee
Print Name
License # and Date of Birth
ADVANCED METAL WORK, INC.—Values You Can Depend On
| Integrity/Honesty | Mutual Trust | Mutual Respect | Growth |
If you have a legal right to
work in the United States,
there are laws to protect
you against discrimination
in the workplace.
In most cases employers cannot
require you to be a U.S. citizen or
permanent resident or refuse any
legally acceptable documents.
No employer can deny you a job or
fire you because of your national
origin or citizenship status.
You should know that –
If any of these things have
happened to you, you may
have a valid charge of
discrimination that can be
filed with the OSC. Contact
the OSC for assistance in
your own language.
Or write to:
The Office of Special Counsel
Civil Rights Division
U.S. Department of Justice
P.O. Box 27728,
Washington, DC 20038-7728
In the Washington, D.C.,
area, please call
202-616-5594, TDD
202-616-5525
Call 1-800-255-7688. TDD
for the hearing impaired is
1-800-237-2515.
Office of Special Counsel for
Immigration-Related Unfair
Employment Practices
U.S. Department of Justice
Civil Rights Division
IF YOU HAVE THE RIGHT TO WORK,
Don’t let anyone take it away.
Si tiene derecho a trabajar
legalmente en los Estados
Unidos, existen leyes para
protegerlo contra la discriminación en el trabajo.
En la mayoría de los casos, los
patrones no pueden exigir que usted
sea ciudadano de los Estados Unidos
o residente permanente o negarse a
aceptar documentos válidos por ley.
Ningún patrón puede negarle
trabajo, ni puede despedirlo, debido
a su país de origen o su condición
de inmigrante.
Debe saber que –
Si se ha encontrado en
cualquiera de estas situaciones, usted podría tener una
queja válida de discriminación.
Comuníquese con OSC para
obtener ayuda en español.
Departamento de Justicia
Llame al 1-800-255-7688.
De los Estados Unidos,
La línea telefónica para
División de Derechos Civiles
personas con problemas
de audición, es
Oficina del Consejero Especial
1-800-237-2515. En
Washington, D.C., llame al
202-616-5594, o al
202-616-5525 (personas
con problemas de audición), o
escríba a la Oficina del
Consejero Especial, División de
Derechos Civiles, P.O. Box 27728,
Washington, DC 20038-7728.
SI USTED TIENE DERECHO A TRABAJAR,
no deje que nadie se lo quite.