Application Form (step 1 of 3)

Personal Data

Name (First, Last): *

Street Address: *

City: *

State: *

Other Names Used:

Business Phone:

Preferred Contact Phone Number: *

E-mail : *

Type of Work Desired

Please indicate the type of position(s) you desire: *

Type of Employment: *

Full-time

Part-time (please indicate hours below)

Summer Only

Hours:

If you indicated "part-time" in the previous question, please let us know what hours you are available to work.

If required, would you be willing to work overtime: *

Shift Desired: *

Day

Swing

Grave

Salary Desired: *

Date Available: *

Have you previously applied for employment at ATR? : *

If yes, date:

Have you previously been employed by ATR?:

If yes, date:

How were you referred to ATR? : *

Name of referrer/source:

Please answer the following questions accurately

1. Have you ever been convicted of a misdemeanor or felony?: *

Exceptions:

Minor traffic citations

Convictions for which the record has been judicially expunged, sealed or eradicated

Convictions for marijuana-related offenses which occurred more than two years ago

2. Are you pending trial for a criminal offense for which you are out on bail or on your own recognizance?: *

If you answered yes to questions 1 or 2, please list dates, places, charges and disposition. *A conviction that is disclosed herein is NOT an automatic disqualification from employment:

Training and Education

High School

High School:

Did you graduate?:

Business College

Business College:

Did you graduate?:

Field of Study:

Diploma/Degree:

Overall Scholastic Average:

College/University

College/University:

Did you graduate?:

Field of Study:

Diploma/Degree:

Overall Scholastic Average:

College/University

College/University:

Did you graduate?:

Field of Study:

Diploma/Degree:

Overall Scholastic Average:

Additional training/classes/certifications:

Employment History

Please list your employment history beginning with your most recent position. This MUST be completed whether or not you are attaching a resume. Employment dates must be consecutive and all times accounted for. Include military service if applicable.

Most Recent Employer

Company Name:

Starting Position :

Last Position:

Start Date:

End Date:

Name of Direct Supervisor/Manager:

Title:

Phone Number:

May we contact this empoyer:

Starting Base Salary:

Final Base Salary:

Description of Duties:

Reason for leaving:

Previous Employer

Company Name:

Starting Position :

Last Position:

Start Date:

End Date:

Name of Direct Supervisor/Manager:

Title:

Phone Number:

May we contact this empoyer:

Starting Base Salary:

Final Base Salary:

Description of Duties:

Reason for leaving:

Previous Employer

Company Name:

Starting Position :

Last Position:

Start Date:

End Date:

Name of Direct Supervisor/Manager:

Title:

Phone Number:

May we contact this empoyer:

Starting Base Salary:

Final Base Salary:

Description of Duties:

Reason for leaving:

Indicate skills in the following areas if applicable

Typing:

What office equipment can you operate proficiently??:

Can you perform the essential functions of the positions applied for, with or without reasonable accommodations?: *

If you answered no to the previous question, please explain the functions that cannot be performed:

In order of proficiency, please list your technical skills:

Professional References

Please give the names of three people in your field (past managers or supervisors) who know you and can provide information regarding your job-related capabilities.

Professional Reference #1

Name:

Title:

Company Name:

Phone Number:

Professional Reference #2

Name:

Title:

Company Name:

Phone Number:

Professional Reference #3

Name:

Title:

Company Name:

Phone Number:

Authorization and Release

Certification
I certify that my answers in this application and in my personal interview are true and correct. I agree that any omissions, misrepresentations or falsifications of information may disqualify me from employment and, if hired, may be grounds for termination of employment.

If understand this application is not an employment contract nor can it be used to create a contract. Employment by ATR has no specific term, regardless of length of service, and may be terminated at the will of either party on notice to the other. I acknowledge that ATR has not made any promises or representations that differ from those in this paragraph. Promises or guarantees of employment on any other basis are not binding for ATR unless they are written and signed by the President of the Corporation.

I hereby authorize ATR to conduct background investigations and check references in association with this application for employment. Further, I authorize any individual, company, business entity, institution, or government agency having relevant information to furnish ATR with that information.

I hereby release and agree to hold harmless any individual, company, business entity, institution or government agency from all liability with regard to furnishing that information to ATR. Further, I hereby agree to release and hold ATR harmless from all liability with respect to receipt of such information.

ATR International, Inc. is an equal opportunity/affirmative action employer.

I have read and understand all the above limitations on and conditions of my employment and authorize the investigation, etc. referred above.: *

I agree.