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Employment Application

Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.

Pre-Employment Agreement

All job applicants at Ameri-Tex Services, Inc. will undergo screening for the presence of illegal or non-prescribed medication as a condition of employment.

Applicants will be required to submit to a urinalysis test at a laboratory chosen by the company. By signing the pre-employment agreement, the job applicant consents to the urinalysis and therefore releases the company of any liability. The job applicant will pay for the pre-employment drug screen and upon negative results will be reimbursed by Ameri-Tex Services, Inc. Any applicant with positive test results will be denied employment at that time.

The company will not discriminate against applicants for employment because of past drug or alcohol abuse. It is the current abuse of drugs, alcohol, or non-prescribed medication that the company will not tolerate.

I agree to submit to a urinalysis (drug screen) as part of my application for employment. I understand that either refusal to submit to the urinalysis screen or failure to qualify according to the minimum standards established by the company for this screen might disqualify me from further consideration for employment.

I further understand that upon commencement of employment with the company, I may again be required to submit to a random or reasonable suspicion urinalysis screen. I understand that refusal to take a requested urinalysis screen or failure to meet the minimum standards set for the screen may result in immediate suspension or termination.

In the event that employment commences prior to the employer receiving the drug test results, I understand that I will be immediately discharged if the result comes back positive.

I understand that in case of an accident while driving a company vehicle I will immediately be tested also.

I acknowledge that as a condition of pre-employment I am required to pay for the initial urinalysis. Upon the result of a negative drug screen I will be reimbursed by Ameri-Tex Services, Inc. on the second full paycheck I receive. I must provide a receipt of payment from DATCS in order or be reimbursed accordingly. In the event of a positive drug screen, I will be denied employment.

I have read in full and understand the above statements and conditions of employment.

Attach Resume:
Applying for:

Applicant Information

*First Name: *Last Name:
*Address: Apartment/Unit #
*City *State
*Phone: Referred By:
Date Available:

Salary Expected:
I can work:  Weekends    Evening    Night
U.S. Citizen:    Yes    No If not, are you authorized to work in the U.S.?:  Yes     No
Languages Spoken:
*Have you ever worked for this company?:  Yes     No
If yes, when?: ------ To ------
*Have you ever been convicted of a felony?
(By company policy some misdemeanors may bar employment):
 Yes     No
If yes, explain briefly:


High School:   Address:
Graduate:    Yes     No   Degree:
College:   Address:
Graduate:    Yes     No   Degree:
Other:   Address:
Graduate:    Yes     No   Degree:


Please list three references not related to you, whom you have known at least one year.
Name: Occupation:
Company: Day Phone Numbers:
Name: Occupation:
Company: Day Phone Numbers:
Name: Occupation:
Company: Day Phone Numbers:

Employment History

Company Name: Complete Address
(w/ City, State, Zip):
Phone: Supervisor:
Job Title: Responsibilities:
Starting Salary: Ending Salary:
Start Date:
  End Date:
Reason for Leaving: May we contact your previous employer for a reference?  Yes    No

Applicant's Statement

Notification and Agreement

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

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 Ameri-Tex Services, Inc

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.