AMTRAC OF OHIO, INC.
APPLICATION FOR EMPLOYMENT
Version: 10/18/2007 

To Submit an Application, Please Print Out this Form,  Fill it Out and Mail it To:
Amtrac of Ohio, Inc.
P.O. Box 508
 Dalton, OH  44618

ADD POSTAGE FOR ANYTHING MAILED OVER 4 PAGES.
YOUR APPLICATION WILL BE REJECTED IF AMTRAC MUST PAY ADDITIONAL POSTAGE TO RECEIVE YOUR MAIL.

All Applicants Must Also Fill Out and Sign the Attached Pre-Employment Drug Testing Program & Policy
Applications Will Be Disregarded and Thrown Out if a Pre-Employment Drug Testing Form is not Signed and Returned With the Application

ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.

Position Sought:   ______________________________________________________________

How did you learn about the position? _______________________________________________

First Name____________________________________

Middle Name__________________________________ (full name, not just initial)

Last Name__________________________

Date of Application__________________    Desired Wage/Salary $__________________

Address__________________________ City________________   State______ Zip_______    

Home Phone ____________________  Office Phone___________________ 

Other Phone_________________   Email Address: ______________________________

On what date would you be available for work? ___________________   

Are you a U.S. citizen, or authorized to work in the U.S. without any restriction? [    ] Yes [    ] No

Have you ever been convicted of a felony?  [    ] Yes [    ] No      

If yes, please describe circumstances: __________________________________________________
_______________________________________________________________________________

Have you ever been involuntarily terminated or asked to resign from any position of employment?  
[    ] Yes [    ] No

If yes, please describe circumstances: _________________________________________________
______________________________________________________________________________

If selected for employment, are you willing to submit to a pre-employment drug screening test?  
[    ] Yes [    ] No

List any other experiences, training, certifications, or licenses held which you feel would make you valuable to our organization:

_____________________________________________________________________________
_____________________________________________________________________________

List other information pertinent to the employment you are seeking:

______________________________________________________________________________

#1.   Employer_____________________________________________

Your Job Title_________________________   Dates Employed___________________________

Address_________________________   City________________ State______ Zip_________

Phone____________________   Name of Supervisor_______________________

Starting Salary____________    Ending Salary_______________

Duties Performed __________________________________________________

Reason for Leaving _________________________________________________

#2.   Employer_____________________________________________

Your Job Title_________________________   Dates Employed_________________________

Address_________________________  City________________ State______ Zip_________

Phone____________________   Name of Supervisor_______________________

Starting Salary____________      Ending Salary_______________

Duties Performed ________________________________________________

Reason for Leaving ______________________________________________

#3.   Employer_____________________________________________

Your Job Title_________________________   Dates Employed_________________________

Address________________________    City_________________ State______ Zip_______

Phone____________________   Name of Supervisor_______________________

Starting Salary____________      Ending Salary_______________

Duties Performed __________________________________________________

Reason for Leaving _________________________________________________

#4.   Employer_____________________________________________

Your Job Title_________________________  Dates Employed______________

Address_________________________   City______________ State________ Zip______

Phone____________________   Name of Supervisor_______________________

Starting Salary____________      Ending Salary_______________

Duties Performed __________________________________________________

Reason for Leaving _________________________________________________

I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days.  Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause.   It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature of Applicant:__________________________________     Date:___________________

Amtrac of Ohio, Inc.
Pre-Employment Drug Testing Program & Policy
Version: 10/18/07

The following is Amtrac of Ohio’s pre-employment drug testing program & policy, to be strictly adhered to:

1)  New employees hired will have a drug test performed prior to starting work at any location.
2)  New employees hired from the field (near project job sites) will be tested at a facility close to the job site, prior to starting work.
3)  If time allows, employees will not start work until a negative test report is received.  A negative or positive test is determined by Amtrac’s Drug-Free Work Place Program – Attachment A (or DOT thresholds as applicable). 
4)  If time does not allow, employees may start work prior to the results being received.
5)  If the pre-employment drug test results come back positive, the employee will be immediately dismissed, and the cost of the drug test will be deducted from their check.
6)  If a new employee quits before completing 100 hours of work, the cost of the pre-employment drug test will be deducted from their pay.
7)  New hires will not be allowed to operate company vehicles or equipment prior to the negative test results being received.  

    * Specific rules apply to CDL drivers, however, Amtrac can hire a driver, and work that individual as a laborer or mechanic, subject to the above conditions. 
** New hires cannot drive a CDL vehicle until cleared personally by Amtrac’s Vice President of Equipment.  This is mandatory, due to ODOT & federal reporting requirements. 

All Applicants and New Hired Employees Must Sign and Return This Form as an Acknowledgement and Agreement to Comply with Amtrac’s Pre-Employment Drug Testing Program & Policy as Stated Above.

I Acknowledge and Agree to Comply with Amtrac of Ohio, Inc.’s Pre-Employment Program and Policy by my signature below:

Applicant / New Hire Signature: ____________________________    Date: __________

Applicant / New Hire Printed Name: _________________________________________

 ( Feel free to attach a resume or other pertinent documentation and mail as directed.)

Version: 10/18/2007