AN EQUAL OPPORTUNITY EMPLOYER

It is the policy of this company to afford employment opportunity regardless of a person’s race, color, national origin, sex, marital status, height, weight, or disability.

Employment Application:

Name(Required)
Address(Required)
Are you 18 years or older?(Required)
DO YOU HAVE THE AUTHORIZATION TO WORK IN THE U.S.?(Required)
DO YOU HAVE THE RIGHT TO REMAIN PERMANENTLY IN THE U.S.?(Required)
HAVE YOU EVER WORKED UNDER A DIFFERENT NAME?(Required)
select one - "other" if unsure
select one - "other" if unsure
Highest Level of Completed Education - select only one
Are you currently employed?(Required)
Please enter a number from 1 to 240.
In Months, please (1-240)

company name
Company Address
Supervisor Name
highest position achieved
In months (1-240)
company name
Company Address
Supervisor Name
highest position achieved
In months (1-240)
company name
Company Address
Supervisor Name
highest position achieved
In months (1-240)

REFERENCE #1(Required)
REFERENCE #2(Required)
REFERENCE #3(Required)

Have you ever been injured on the job?(Required)
where you had to leave work that day
ACP's attendance policy states that you must be at work on time every day. Are you able to abide by this policy if hired by ACP?(Required)
Will you consent to a drug screening?(Required)
Do you have a valid Driver's License?(Required)
Do you have reliable transportation?(Required)
Will you travel nationally, if required?(Required)
MM slash DD slash YYYY
Accepted file types: pdf, Max. file size: 8 MB.
Please Read the following Statements Carefully before clicking SUBMIT

I certify that all information provided in this employment application is true and complete. I understand that any false information may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that I will be required to pass a drug screening examination. I hereby consent to a pre-employment drug screen as a condition of my employment. I understand that if I am extended employment it may be conditioned upon my successfully passing a complete physical examination. I consent to the release of any and all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AN AGREEMENT MUST BE IN WRITING AND SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. I have read, understand, and by my submitting consent to these statements.

Consent(Required)