Employment Application

Please fill in the application below, providing as much information as possible. When you are done, "submit" the application, and we will contact you as soon as possible to follow up.

Position Applied For:
Last Name: First: Middle:
Address:
City: State: Zip:
Phone Number: Alternate Number:
Social Security Number:
Are you at least 18 years of age? If not, state your age:

Do you have any physical, mental or medical impairments that may limit your ability to perform the job for which you have applied?


Date available for work:
Are you available to work weekends?
Salary requirements:

Education


Please state highest level of education completed:
Name of last school attended:
Address of last school:
Special Training:

Work History(List order--last or present employer first)


Date Employed
MM/DD/YY
Name & Address of Employer
Supervisor
Reason Left
From
To









References: Please name 3 persons other than relatives or former employers.





Have you ever been convicted of a felony or misdemeanor?
If yes, explain fully below. (Note: A criminal conviction will not necessarily be a bar to employment. Any relevant factors such as age at the time of offense, seriousness and nature of the violation, and rehabilitation will be taken in to account as well as type of conviction relative to position applied for.)


Agreement

By checking the box below, I hereby certify that the answers given in this application for employment and any supporting documentation are true and correct to the best of my knowledge. I authorize investigation of all statements contained in this employment application as may be necessary in reaching an employment decision.

I understand that misrepresentation, omission, or falsification of facts in this application or during a pre-employment interview, including a failure to disclose requested information, may result in my discharge. I also understand that I will be required to undergo a background check and a review of my motor vehicle record before a final offer of employment is made.

I understand that any employment relationship with this employer is "at will," which means that the employee may resign at any time and the employer may discharge the employee at anytime, with or without cause. I also understand that this at-will employment relationship may not be changed by any written document or behavior, unless the change is specifically acknowledged in writing by Atkins Inc.'s Vice President of Administration.

By checking this, I hereby agree to the statment above.


An Equal Opportunity Employer