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Employee Application
Note: Any item marked with a red asterisk "*" is a mandatory field and must be completed. If the field does not apply to you, please enter "N/A" to complete the form.
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AK Constructors, Inc. EMployment Application
1751 Jenks Dr. Corona, CA 92880 Phone: 951.280.0269 / Fax: 951.280.0234
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A. PERSONAL INFORMATION
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Name*
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Nickname*
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Address*
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Home Number*
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Mobile Number
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Email Address*
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Email Address Confirmation*
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Social Security Number*
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How did you hear about us?*
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B. AVAILABILITY
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Today's Date*
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Date Available to Start*
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Looking For*
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Position Applying For*
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Travel Availability*
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C. EMPLOYMENT HISTORY
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Most Recent Employer
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I have been employed before*
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[radio* emp1_workbefore default:1 "YES" "NO"]
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If "Yes", please complete the following:
Company*
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Phone Number*
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Job Title*
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Start Date*
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End Date*
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Supervisor's Name*
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Duties*
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Reason for Leaving*
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Second Most Recent Employer
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I have been employed twice before*
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[radio* emp2_workbefore default:1 "Yes" "No"]
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If "Yes", please complete the following:
Company
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Phone Number
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Job Title
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Start Date
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End Date
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Supervisor's Name
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Duties
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Reason for Leaving
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D. EXPERIENCE
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Transportation and License Information
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Do you have a reliable mode of transportation?*
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[radio* reliable_transportation default:1 "Yes" "No"]
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If the job requires, do you have a valid appropriate drivers license?*
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[radio* drivers_license default:1 "Yes" "No"]
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Driver's License Number*
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State Issued*
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Experience
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How many months/years of experience do you have in the position you are applying for?*
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What types and makes/models of construction equipment can you operate?*
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Please list any tools that you possess that you would utilize for your position.*
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List any craft training programs in which you have participated in or any certifications you have obtained*
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Are you currently OSHA Certified?*
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If "Yes", please list Certificate #*
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Are you fluent in a language other than English?*
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Please list any other special qualifications that you have that may be helpful for us to know.*
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E. EDUCATION
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Please List All High Schools Colleges, Universities & Vocational/Tech Shools You Have Attended.*
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F. EMERGENCY INFORMATION
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Emergency Contact 1
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Name*
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Relationship*
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Phone Number*
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Emergency Contact 2
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Name*
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Relationship*
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Phone Number*
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G. SECURITY
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Place of Birth (Provide City and State)*
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Required for secured facilities: Please provide Birth Certificat # or Passport #.*
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H. EEO-1 Self-Identification
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AK Constructors is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
As employers/government contractors, we also comply with government regulations including but not limited to affirmative action responsibilities as required under Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, section 4212 of the Vietnam Era Veterans Readjustment Act of 1974 and Veterans Employment Opportunities Act (VEOA) of 1998.This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.If you wish to be identified, please complete the information in this section:
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Referral Source
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If you wish to be identified, please sign below and complete the survey:
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Gender:
MaleFemale
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Ethnicity: Are you Hispanic or Latino?No, I am not Hispanic or Latino.Yes, I am Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race.
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Race — IMPORTANT — Only complete this section if you checked "No, I am not Hispanic or Latino" in the Ethnicity section above:What is your race? Select ONE of the following categorie(s):White — A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.Black or African American — A person having origins in any of the Black racial groups of Africa.American Indian/Alaskan Native — A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.Asian — A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.Native Hawaiian or Other Pacific Islander — A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.or More Races — All persons who identify with more than one of the above five races.
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Veteran - As defined under one or more of the following:
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002,38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
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A "disabled veteran" is one of the following:
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a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
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a person who was discharged or released from active duty because of a service-connected disability.
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A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
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An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
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An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Protected veterans may have additional rights under USERRA-the Uniformed Services Employment and Reemployment Rights Act. ln particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
lf you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA..
I identify as one or more of the Classifications of Protected Veteran Listed AboveI am Not a Protected VeteranI do not want to self-identify
Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended.
The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.
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Voluntary Self-ldentification of Disability
Why are you being asked to complete this form?
Because we do business with the government, you must reach out to, hire, and provide equal opportunity to qualified people with disabilities. (i) To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disabilities. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for e job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required ta ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilites include, but are not limited to:
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Blindness ·Deafness
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Cancer ·Diabetes ·Epilepsy
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Autism ·Cerebral palsy
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HIV/AIDS ·Schizophrenia
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Muscular dystrophy
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Bipolar disorder ·Major depression
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Multiple screrosis (MS)
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Missing limbs or partially missing limbs
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Post-traumatic stress disorder (PTSD)
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Obsessive compulsive disroder
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Impariments requiring the use of a wheelchair
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Intellectual disability (previously called mental retardation)
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Please Check on of the boxes below:
Yes, I HAVE A DISABILITY (or previously has a disability)NO, I DON'T HAVE A DISABILITYI DON'T WISH TO ANSWER
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
i Section 503 sf the Rehabilitation Act of f 973, as amended. For more information about this form or the equal employment obligations of Federal contractors, vis?t the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at
www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
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I. APPLICATION VERIFICATION
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"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon. I authorize investigation of all statements contained herein and to do background checks to give you all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from liability for any damage that may result from furnishing same to you. I realize that pre-employment drug testing could be a condition of my employment.I realize that pre-employment drug testing will be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time. I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all the rules and policies of my employer."By signing below you agree that you have read and understand the above statement and that all the information included on this application is true to the best of your knowledge.
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Digital Signature*
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Date
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Actual Signature
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Your signature will be required at the time of interview.
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