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*Required Fields

Atwoods is a drug free environment. No association or usage will be tolerated. If you have a disability requiring some form of accommodation in order to complete the application process or to take any pre-employment tests which may be given, you may VOLUNTARILY identify in the following space, the type of accommodation necessary. Employees are treated during employment, without regard to race, color, religion, sex, national origin, age, disability or any other prohibited basis of discrimination, as provided under applicable state and federal law.

Failure to answer and fill out any section may result in a non-hire status.

DATE/REFERRAL INFORMATION *STORE LOCATION
Date of Application
*Referral Source:
  Advertisement Employment Agency
Relative Walk-In Friend
Other
1. HOW DO WE CONTACT YOU?
*Last Name
*First Name
*Middle
*Mailing Address
*City
*County
*State
*Zip Code
  *Home Phone
2nd Number (optional)
*E-Mail
2. BACKGROUND INFORMATION
Are you 16 years of age or older?
  YES NO
Are you a U.S. Citizen or are you legally authorized to work in the U.S.?
  YES NO
If a conditional offer of employment is made, you will be required to provide identification and proof of citizenship or authorization to work in the U.S.
Have you ever been employed with Atwoods?
  YES NO
If yes, where? Date?
/ /
Month Day Year
Are you in any way related to any present Atwoods employees?
  YES NO
Who? How?
Have you ever been convicted, pled "guilty" or "no contest" to a criminal, civil, felony, or misdemeanor charge?
  YES NO
(This includes: DUI, drug or alcohol offenses, etc. This excludes: minor traffic offenses. A guilty plea will not necessarily disqualify an applicant from employment. The recency, severity and pertinence of the charge to the job will all be considered.) Failure to answer and fill out this section will result in a non-hire status.
If "YES", please explain:
Have you served in the U.S. Armed Forces?
  YES NO
Date of Entry
/ /
Month Day Year
Branch of Service
Date of Discharge
/ /
Month Day Year
Final Rank
Indicate service school attended or special training received
3. EMPLOYMENT INTEREST
*Position(s) applied for:
Salary desired:
Date you can start:
/ /
Month Day Year
Are you available to work:
  Full-Time Part-Time Temporary
What Days: SU MO TU W TH F SA
4. EDUCATION
Name/Location of High School
Received:
  Diploma None Other (specify)
Your Name, if Different While Attending School:
COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (transcripts may be required)
NAME OF SCHOOL LOCATION NO. OF YEARS COMPLETED TRAINING COMPLETED? MAJOR/MINOR COURSE OF STUDY TYPE OF DEGREE/DIPLOMA EARNED
  YES NO
  YES NO
  YES NO
  YES NO
  YES NO
5. PERIODS OF EMPLOYMENT
Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate, for example, race, color, religion, sex, disability or national origin. If this will be your first job opportunity, please check here. (If checked, skip to SEC. 6)
A.
Name of Present or Last Employer:
Address
Phone No.
Your Job Title:
Supervisor's Name:
From:
/ /
Month Day Year
To:
/ /
Month Day Year
Hours per Week:
Your Name if Different During Employment
Duties and Responsibilities:
Reason For Leaving
B.
Name of Next Previous Employer:
Address
Phone No.
Your Job Title:
Supervisor's Name:
From:
/ /
Month Day Year
To:
/ /
Month Day Year
Hours per Week:
Your Name if Different During Employment
Duties and Responsibilities:
Reason For Leaving
C.
Name of Next Previous Employer:
Address
Phone No.
Your Job Title:
Supervisor's Name:
From:
/ /
Month Day Year
To:
/ /
Month Day Year
Hours per Week:
Your Name if Different During Employment
Duties and Responsibilities:
Reason For Leaving
May we contact your present employer?   YES   NO
6. KNOWLEDGE/SKILLS/ABILITIES (KSAs)
List KSAs you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc.
*7. PERSONAL REFERENCES (Do not list relatives or former employers)
Last Name
First Name
Mailing Address
City
State
Zip
Phone
Number
Years
Known
8 APPLICANT’S STATEMENT
These answers are true and complete to the best of my knowledge. The Company may investigate all statements contained in this application, and I understand that any false or misleading information provided may result in my immediate discharge. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT AND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND THE COMPANY IS TERMINABLE-AT-WILL. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING. I also understand that any offer of employment may be conditional upon a fit for duty evaluation by a doctor selected by the Company, to determine whether I can perform the job duties. In addition, I understand a drug or alcohol test may be required depending on Company policy. I authorize the Company to make a thorough investigation of my criminal background, past employment, education and job-related activities and I release from all liability all persons, companies, and corporations supplying such information. I also indemnify this Company against any liability which might result from making such investigation. Additionally, I authorize the Company to supply my employment record, in its sole discretion, in whole or in part, to any prospective employer, government agency or other party with an interest that the Company deems appropriate.

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