Apache Construction Co. — DBA

Arizona Highway Safety Specialists

Guardrail ★ Signs

762 E. Road 2 South, Chino Valley, AZ 86323(928) 636-8934azhss@azhss.com
Certified DBE #5123ROC #175447

Application for Employment

Complete the form below — it takes about 5 minutes. All fields marked with * are required.

Personal Information

Please Print

2. Have you been convicted of a felony?*

Educational History

SchoolName & LocationYears CompletedDegree/Diploma
Elem./Jr. High
High School
College
Tech Training
Other

Employment Record (last 3 years)

We will contact the employers listed unless you specifically exclude them below.

1. Employer

2. Employer

Reference

Not a relative or former employer.

Work Availability

2. Do you have any objection to working overtime?*
3. Can you work overtime without prior notice?*
4. Can you work some Saturdays?*
5. Can you work some Sundays?*
6. Can you work out of town on a regular basis?*
7. Do you have appropriate shoes and clothing to work in extreme heat, cold, snow or rain?*
8. Can you do work that requires lifting of 80 lbs. on a regular basis?*

Compensation

If your application receives favorable consideration, what hourly rate would you require?

per hour

Invitation to Self Identification

for persons with handicaps, special disabled veterans, veterans of Vietnam era and members of a minority race

Arizona Highway Safety Specialists is a Federal Contractor subject to the requirements of the Vietnam Era Veterans Re-Adjustment Assistance Act of 1974, as amended (38USC 2012), and to the requirements of Section 503 of the Rehabilitation Act of 1973, and their implementing regulation. These Acts and Regulations require that Arizona Highway Safety Specialists take affirmative action to employ, and to advance in employment, qualified persons with handicaps, special disabled veterans, and veterans of the Vietnam Era.

If you are a person with a handicap, a special disabled veteran, minority, or a veteran of the Vietnam Era, and would like to be considered under the Affirmative Action Program, please tell us. Provision of this information is voluntary. If you do not wish to identify yourself at this time as a person with a handicap, a special disable veteran, or a veteran of the Vietnam Era, you need not be subject to adverse treatment. If you do wish to identify yourself, the information provided will be used only in accordance with the Acts and Regulations. This means the information provided will be:

  1. Kept confidential, except that:
    1. Supervisors and managers may be informed of any restrictions on work duties of a persons with handicaps or special disabled veterans, and of any necessary accommodations.
    2. First aid and safety personnel may be informed, when and to the extent appropriate, if a particular handicap or disability may require emergency treatment.
    3. Government officials investigating compliance with the Acts shall be informed.
  2. Used only in accordance with the Acts and their implementing regulations and
  3. Used to ensure proper placement. In order to assist us in making proper placement, we ask that if you have a handicap or disability which might affect your job performance or create a hazard to yourself or others in connection with the job for which you are applying, you tell us:
    1. What skills and/or procedures you use or intend to use to perform the job notwithstanding the disability
    2. What accommodations we could make which would enable you to perform the job properly and safely. This might include special equipment, changes in the physical layout of the job, elimination of certain non-essential duties, or other accommodations.

I certify that I have read the above "INVITATION TO SELF IDENTIFICATION" and that I understand its terms. I further attest, by checking the appropriate block and signing below, that I am:

Certification & Signature

Please read each statement carefully and check to confirm. Typing your full name below serves as your legal electronic signature under the federal ESIGN Act and Arizona's Uniform Electronic Transactions Act.

Your information will be sent securely to AHSS HR.

Disclosures

Equal Opportunity Employer. Arizona Highway Safety Specialists is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Employment Authorization. Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, passport, permanent resident alien ID card, etc.) prior to being hired.