Employment Application

Amherst Madison, Inc. is an Equal Opportunity Employer, including disability/vets.


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Step 1

Personal Information

Step 2

Voluntary Disclosures

Amherst Madison, Inc. is a federal contractor and an equal opportunity employer.  The Equal Employment Opportunity Commission (EEOC) and the Office of Federal Contract Compliance Programs (OFCCP) requires organizations to complete various reports each year.  Amherst Madison, Inc. invites you to self-identify gender, race/ethnicity, veteran status, and disability status if you choose to do so.  Completion of this data is VOLUNTARY and will not affect your opportunity for employment, or terms or conditions of employment.  

Why Are You Being Asked to Complete This Form?

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). VEVRAA requires Government contractors to take affirmative action to employ and advance in employment protected veterans. To help us measure the effectiveness of our outreach and recruitment efforts of veterans, we are asking you to tell us if you are a veteran covered by VEVRAA. Completing this form is completely voluntary, but we hope you fill it out. Any answer you give will be kept private and will not be used against you in any way.


For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How Do You Know if You Are a Veteran Protected by VEVRAA?

Contrary to the name, VEVRAA does not just cover Vietnam Era veterans. It covers several categories of veterans from World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War which is defined as occurring from August 2, 1990 to the present.


If you believe you belong to any of the categories of protected veterans please indicate by checking the appropriate box below. The categories are defined on the next page and explained further in an “Am I a Protected Veteran?” infographic provided by OFCCP.

What Categories of Veterans Are “Protected” by VEVRAA?

“Protected” veterans include the following categories: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These categories are defined below.


  1. A “disabled veteran” is one of the following:
    • 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
    • a person who was discharged or released from active duty because of a service-connected disability.
  2. 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.
  3. 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.
  4. 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.

This information is voluntary and will not affect your consideration for the position you are applying for.

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.


Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:


  • Alcohol or other substance use disorder (not currently using drugs illegally)
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Diabetes
  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
  • Intellectual or developmental disability
  • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
  • Missing limbs or partially missing limbs
  • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
  • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
  • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
  • Partial or complete paralysis (any cause)
  • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
  • Short stature (dwarfism)
  • Traumatic brain injury

OMB Control Number 1250-0005

Expires 04/30/2026


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.  


This information is voluntary and will not affect your consideration for the position you are applying for.

Step 3

Employment History

Provide the following information for your past employers.

Step 4

Education & Skills

Step 5

Professional References

Persons not related to you who are familiar with your experience, training and character. Examples: employers, supervisors, teacher or co-workers.

Step 6


Attach your resume in Word (*.doc, *.docx) or PDF (*.pdf) format.

Job Applicant's Agreement & Certification

I certify that I have answered all inquires on this application truthfully to the best of my knowledge and belief. I understand that my failure to disclose, or my falsification of, any information requested of me during the pre-employment process may disqualify me from consideration for employment or lead to the termination of my employment.


I understand that, as part of its pre-employment process, Amherst Madison, Inc. requires that all applicants to whom an offer of employment is extended must undergo a physical examination and physical evaluation of overall fitness to determine if I can perform the essential functions of the job, with or without reasonable accommodation. I also understand that Amherst Madison, Inc. requires post-offer urine drug testing for towboat applicants. I understand and agree that any offer of employment Amherst Madison, Inc. may extend is contingent upon obtaining a negative result on the drug testing. I further understand that any applicant who tests positive for drugs or who fails or refuses to undergo the drug testing will be ineligible for employment at Amherst Madison, Inc., in accordance with Company policy and applicable Coast Guard regulations, 46 CFR Part 16.


I understand that all employment relationships with the Company are "at will," which means that I may resign at any time and the Company may discharge me at any time with or without cause. I further understand that no manager or representative of the Company, other than the President, has the authority to enter into any promises or commitments contrary to the above, including making any agreement for employment for any specified period of time, and that any such agreement must be in writing and signed by the President and the affected individual.



Confidential AMHERST MADISON, INC. Voluntary Self-Identification

Amherst Madison, Inc. is an equal employment opportunity employer and a federal contractor. Individuals are considered for positions at Amherst Madison, Inc. without regard to race, color, creed, religion, sex, national origin, age, marital status, veteran status, disability and any other legally protected status. Amherst Madison, Inc. is also subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Amherst Madison, Inc. invites employees and job seekers to voluntarily self-identify their gender, race and ethnicity, veteran status, and disability status.  If you choose not to provide this information, it will not affect any opportunities for employment or benefits.