We’re Hiring! Employee Application APPLICATION FOR EMPLOYMENT The following information is requested in order to help us make the best placement within the company. All portions of this application pertaining to you must be completed. We appreciate the time you spend in filling in this application form. AMS, in accordance with the State and Federal laws, does not discriminate on the bases of age, religion, sex, national origin, marital status, physical or mental handicap or arrest record.PERSONAL INFORMATION Name(Required) Last First Middle Primary Phone(Required)SS#(Required)Date of Birth(Required) MM slash DD slash YYYY Secondary Phone(Required)Emergency Contact(Required)Contact's Phone(Required)Relationship(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 How where you referred to AEIS?Are you legally eligible for employment in the United States?(Required)YesNo(Proof of citizenship or immigration status is required)Do you have a (TWIC) Transportation Workers Identification Card?(Required)YesNoDo you have a Passport?(Required)YesNoIf no, are you able to get one within 30 days of beginning employment?(Required)YesNoAre you at least 21?(Required)YesNoDo you have a valid driver’s license?(Required)YesNoHave any licenses, permits, or privileges ever been suspended or revoked?(Required)YesNoHave you ever applied for employment at AEIS?(Required)YesNoIf yes, When?(Required)Have you ever been employed at AEIS?(Required)YesNoIf yes, When?(Required)Are you related to any AEIS employee?(Required)YesNoIf yes, Give Name(Required)Department(Required)Relationship(Required)Have you been convicted of a felony offense?(Required)YesNoA conviction does not automatically disqualify you from employment. The date, nature and seriousness of the offence will be considered in relation to specific job requirements.If yes, indicate type(s) and date(s) of conviction(Required)Job Requirements Position applied for Field/Shore Technician: Foreman: Supervisor: Insulator Mechanic Insulator Foreman Insulator Supervisor Shop Mechanic Welder Shop hand Vessels Deckhand Captain (100 Ton Master License Required) Admin Admin Asst Invoicing Payroll House Keeping Type of Employment Full Time Part Time Summer Temporary Are you willing to work additional hours?(Required)YesNoNights?(Required)YesNoWeekends?(Required)YesNoHolidays?(Required)YesNoAre you able to work away from home for at least two or more weeks at a time?(Required)YesNoPlease explain any reason why you would not be able to perform the essential functions of the job for which you are applying.Salary requirements(Required)Available employment date MM slash DD slash YYYY EDUCATION High school NameCityStateHonors and achievementsDid you graduate?(Required)YesNoOther Institution NameCityStateHonors and achievementsDid you graduate?(Required)YesNoName of DegreeDate degree obtained(Required) MM slash DD slash YYYY Other Institution NameCityStateHonors and achievementsDid you graduate?(Required)YesNoName of DegreeDate degree obtained(Required) MM slash DD slash YYYY Extracurricular activitiesUse the space provided to list additional interests, skills, or qualifications that you possess that you feel qualify you for the position for which you are applying EMPLOYMENT RECORD (Required to be filled out completely) Please list experience from the past 10 years, beginning with the most recent. (Please attach additional sheets if required.) Employed byPhoneSupervisorAddress 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 Employed from MM slash DD slash YYYY Employed to MM slash DD slash YYYY Salary fromSalary toJob descriptionHonors and achievementsReason for LeavingMay we contact them for references?YesNoEmployed byPhoneSupervisorAddress 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 Employed from MM slash DD slash YYYY Employed to MM slash DD slash YYYY Salary fromSalary toJob descriptionHonors and achievementsReason for LeavingMay we contact them for references?YesNoEmployed byPhoneSupervisorAddress 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 Employed from MM slash DD slash YYYY Employed to MM slash DD slash YYYY Salary fromSalary toJob descriptionHonors and achievementsReason for LeavingMay we contact them for references?YesNoEmployed byPhoneSupervisorAddress 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 Employed from MM slash DD slash YYYY Employed to MM slash DD slash YYYY Salary fromSalary toJob descriptionHonors and achievementsReason for LeavingMay we contact them for references?YesNoEmployed byPhoneSupervisorAddress 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 Employed from MM slash DD slash YYYY Employed to MM slash DD slash YYYY Salary fromSalary toJob descriptionHonors and achievementsReason for LeavingMay we contact them for references?YesNo CERTIFICATION Read carefully. If you have any questions regarding these statements, please ask the personnel representative before signing. Certify(Required) I Agree“I certify that the information contained in this application, and accompanying resume, if any, is true and complete to the best of my knowledge and understood that falsification, misrepresentation and/ or omission of information may be grounds for refusal to hire or, if hired dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, training, or any other information that they may have, personal or otherwise with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information unless otherwise indicated in the employment section of this application.”Certify(Required) I Agree“In the event of my employment, I agree to conform to the rules and regulations of American Environmental & Industrial Services, LLC and acknowledge that these rules and regulations may be changed, interpreted, withdrawn or added to by AEIS at any time. I understand that this application will be given every consideration by its receipt does not imply that I will be employed. I understand that this employment application and any other AEIS documents are not contracts for employment. My employment and compensation can be terminated at any time with or without cause and with or without notice at the option of either AEIS or myself.”Certify(Required) I Understand“I understand that AEIS will require me to undergo a drug test by medical staff and/ or agent authorized by AEIS as a condition of my employment and continued employment. I further understand that I must successfully pass the drug test to be considered for employment with AEIS. I understand that medical examinations which are job-related and consistent with AEIS business necessities may be required of me once I am employed. I further release AEIS including all of its officers, agents, representatives and employees from any and all claims, suits, causes of action, liability and damages associated with or arising from my submission to a drug test and/ or medical examination. I also understand that AEIS may enforce a restricted smoking environment.Certify(Required) I Agree“I represent and warrant to AEIS that (1) I am not a party to or otherwise subject to an employment agreement, non complete agreement, whether written or oral, or other limitation, restriction or obligation that would prevent me from accepting a position with AEIS. (2) I am not appropriating, taking or bringing from my former employer or other entity and trade secrets or other proprietary, confidential information concerning my former employer, or other entity, and its respective operations, including, without limitation, customer lists, patents, trademarks and other similar matters, and (3) to my knowledge, I am free to accept or reject the applied for position and I have not been coerced or otherwise persuaded to accept or reject the applied for position.”Signature(Required)Date MM slash DD slash YYYY CAPTCHA
