Employment Application

ACMH is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, sexual orientation, gender identity, marital status, national origin, disability, or veteran status or any other characteristic protected by state, federal, or local law.

This institution is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

NOTE: Newly hired ACMH employees must show proof of full COVID-19 vaccination or receive at least one dose of the two-dose COVID-19 vaccines (Pfizer or Moderna) or have received the single dose of the Johnson & Johnson COVID-19 vaccine before they can begin work. Newly hired employees will be required to receive the second dose within three or four weeks of the initial vaccine depending on the vaccine protocol for that particular vaccine (Pfizer or Moderna). Reasonable accommodations may be available for individuals who are granted an exemption due to religious or medical reasons.


Please note that application information is saved as you enter it.
  • Personal Information


  • Job Interests

  • If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986.

  • Employment History

  • First Employer

    We will only contact the employer if a contingent offer is made.

    Second Employer

    Third Employer

    Fourth Employer


  • Education Record


  • Additional Information

  • Professional License Information

    If applicable, list all professional licensure information.
  • Select date MM slash DD slash YYYY
  • If applicable, list all professional registration/certification information.
  • Select date MM slash DD slash YYYY

  • Pre-Interview Questions


  • Employment References (must be professional work related references, 3 are required)

    Give Name(s) of person(s) we may contact to verify your qualifications for the position
  • First Reference

  • Second Reference

  • Third Reference


  • To the best of my knowledge, all of the information I have submitted on this application is true and complete. I understand that any omission or falsification of information will be sufficient cause for disqualification from further consideration for employment or for dismissal. I voluntarily give this organization the right to make a thorough investigation of my personal or past employment history and education, as well as to perform criminal history, dependent adult and child abuse checks. I agree to cooperate in such investigation and authorize any former employer, person, firm or corporation to give this organization any information they may have regarding me. In consideration of this organization's review of this application, I release this organization and all providers of information from any liability as a result of furnishing and receiving this information. I understand that any offers of employment are contingent on successful completion of the post-offer exam and background checks. I understand employment at this organization is "at will," which means employment may be terminated by the employee, or by this organization at any time, with or without cause. I further understand employee benefits, terms and conditions of employment and the policies, procedures and work rules of the organization may be determined, changed and modified from time to time by this organization without limitation or agreement. I also understand any employment handbooks or manuals that may be distributed to me by this organization shall not be construed as a contract. I hereby agree that if I become employed by this organization, I consent to the release of all my future educational records involving classes, coursework, seminars and all other educational programs in which I am enrolled or attend and for which a portion or all of the enrollment fee, or tuition will be paid by this organization to an accredited higher education institution. This consent will be effective on my date of employment and until I specifically revoke it in a signed and dated writing delivered to the higher education institution.
  • Accepted file types: pdf, doc, docx, txt, rtf, Max. file size: 128 MB.