AQHA Employment Application

PLEASE DESCRIBE ANY OTHER EDUCATION OR TRAINING COURSES YOU HAVE HAD WHICH ARE RELEVANT TO THE POSITION FOR WHICH YOU ARE APPLYING.

PLEASE DESCRIBE YOUR SKILLS AND ABILITIES THAT QUALIFY YOU FOR THE POSITION FOR WHICH YOU ARE APPLYING. CLERICAL APPLICANTS SHOULD INCLUDE TYPE OF OFFICE MACHINES AND SPEED OF OPERATION.

THREE REFERENCES ARE PREFERRED, BUT NOT REQUIRED

AQHA is an Equal Opportunity Employer. As required by law, we track certain information for government reports such as EEO-1 Reports and Affirmative Action Plans.  
 
Applicants for employment are invited to participate in the Affirmative Action Program by reporting their Race/Ethnic Identity, Gender, and Veteran Status. Be advised that: (a) workers (applicants) are under no obligation to respond but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for government reporting purposes. We are a company that values diversity. We actively encourage women, minorities, and veterans to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please complete the information requested below. 

 -Hispanic or Latino (All Races) - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

 -American Indian or Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintain 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.

 -Black or African American - A person having origins in any of the black racial groups of Africa.

  -Native Hawaiian or Other Pacific Islander - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

  -White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

  -Two or More Races - A person who identifies with more than one of the above races.

Disabled Veteran defined as (i) 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 (ii) a person who was discharged or released from active duty because of a service-connected disability.  
 
Other Protected Veteran defined as 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.  
 
Armed Forces Service Medal Veteran defined as 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 (61 FR 1209, 3 CFR, 1996 Comp., p. 159).  
 
Recently Separated Veteran defined as a veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty who served on active duty in the U.S. military, ground, naval or air service.

No Military Service defined as a person who has never served in the armed forces of the United States.

Individual with Disability(s) defined as a person who (1) has a physical or mental impairment which substantially limits one or more of his or her major life activity(s), (2) has a record of such impairment(s), or (3) is regarded as having such impairment(s), who meets the job-related requirements of a particular job and is capable of performing that job, with or without reasonable accommodation for his or her disability. 

Because we do business with the government,  we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. 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 disability. Completing this form is voluntary but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept in 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 to 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.

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.

Disabilities include, but are not limited to:

-Blindness  -Autism                  -Bipolar Disorder               -Post-traumatic stress disorder (PTSD)

-Deafness   -Cerebral Palsy    -Major Depression            -Obsessive compulsive disorder

-Cancer       -HIV/AIDS                -Multiple Sclerosis (MS) - Impairments requiring the use of a wheelchair

-Diabetes    -Schizophrenia    -Missing or partially missing limbs   -Intellectual Disability (previously called mental retardation)

-Epilepsy     -Muscular Dystrophy

I certify that all of the information provided by me in this application is true and complete, and I understand that any misstatement, falsification, or omission of information is grounds for refusal to hire, or, if hired, termination.
I Authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result for furnishing such information to you.
I authorize you to request, receive and verify all information given on this application.
I further acknowledge that if I am employed by the employer, my employment will be at-will, and may be terminated with or without cause by me or by the employer.
I agree to conform to the rules and regulations of the company, and my employment and compensation can be modified or terminated with or without cause, and with or without notice, at amy time, at the option of either the company or myself.  I understand that no manager or representative of the company other than the Executive Vice President or the Treasurer has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, either prior to commencement of employment or after I have become employed.