Application For Employment

PERSONAL INFORMATION

First Name		Middle Name		Last Name

Address		City		State	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip

Phone Number	()	-		Email

Have you ever worked for American Color Imaging?	No Yes

When?

Do you have any relatives currently employed by American Color Imaging?	No Yes

Name

Are you a military Veteran?	No Yes

Dates of Active Duty To

Have you ever been known by any other name(s) to verify any of the information on this application? No Yes

Names

How did you hear about us?

EMPLOYMENT DESIRED

Position Applied For:		Date available:

Are you available for work (you must check at least one):	Full Time	Part Time	Seasonal

Wage Desired:

What shifts are you available to work? (you must check at least one)	1st Shift	2nd Shift

EDUCATION

Do you have a High School Diploma or GED?	Yes No

Name of last school attended:		City:		State:	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Last year of school completed:	-- 6 7 8 9 10 11 12 14 15 16 17 18	Highest degree earned:	-- High School Diploma GED Certificate AA BA/BS MD PHD Other

Area of Concentration and/or degree(s), certificates, licenses or endorsements:

Other Training or Skills (Factory or Office Machines Operated, Special Courses, Computer Skills, etc:

EMPLOYMENT HISTORY

List employers, starting with the current or most recent. Explain all gaps in employment.

Company Name:		Job Title:

Address		City		State	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip

Start Date:		End Date:		Rate of Pay:

Detailed Job Duties:

Reason for leaving:

Company Name:		Job Title:

Address		City		State	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip

Start Date:		End Date:		Rate of Pay:

Detailed Job Duties:

Reason for leaving:

Company Name:		Job Title:

Address		City		State	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip

Start Date:		End Date:		Rate of Pay:

Detailed Job Duties:

Reason for leaving:

May we contact your former employers to verify this information?	Yes No

May we contact your present employer?	Yes No

Please provide any additional information about your abilities or interests that make you a good candidate for this position:

You may upload your resume here: 

I authorize investigation of all statements contained in the application. I understand that ommision or misrepresentation of facts is cause for dismissal. I understand that completing this form does not constitute an offer of employment or an employment agreement between me and ACI.

I,  ,by typing my name below am providing my electronic signature. I understand and agree that my electronic signature initiates submittal and that this document may be used by American Color Imaging as deemed necessary for employment purposes. I understand and agree that the electronic signature filed in electronic form shall have the same legal force and effect as my hand written signature.

Electronic Signature:			Date:

Federal and Iowa law prohibit discrimination in hiring due to age, race, color, creed, sex, national origin, religion, disability or veteran's status. Iowa law also prohibits discrimination on the basis of sexual orientation and gender identity.