New Hire Employment Application

Section #1

Date of job offer*

Name*

First Middle Last

Date of birth*

Social Security Number*

(no dashes)

Home Phone

Work Phone

Current Address*

Apt or Unit # Street Address City State ZIP Code

Prior Address

Apt or Unit # Street Address City State / Province / Region ZIP / Postal Code

AVAILABILITY

For which position are you applying?*

What date can you start?*

What category would you prefer?*

Full-time
Part-time
Temporary
Labor pool

For which schedules are you available?*

Weekdays
Weekends
Evening
Nights
Overtime
Shift
Other

*

*reasonable efforts will be made to accommodate religious beliefs and practices.

Injury	Date of Injury	Employer	Body Part Affected	Cause	Amount of the Lost Time	Any permanent Disability	Was Workers' Comp. Claim Filed?

Injury	Date of Injury	Body Part Affected	Cause	Days in Hospital	Days of Lost Work Time	Have you recovered?

Step 1 of 6

Section #1

AVAILABILITY

Section #2

JOB-RELATED SKILLS

SECURITY

COMMENTS

PREVIOUS EMPLOYERS

MOST RECENT EMPLOYER

SECOND MOST RECENT EMPLOYER

THIRD MOST RECENT EMPLOYER

REFERENCES

EDUCATION

Section #3

EMERGENCY INSTRUCTIONS

HEALTH AND SAFETY

Section #4

MASTER DATA SHEET

NEW EMPLOYESS

PAYROLL DIRECT INFORMATION AND CHECK STUB DELIVERY REQUEST

PAYROLL CHECK STUB DELIVERY REQUEST

ATS CONSTRACTION 401K VOLUNTARY PROGRAM

Section #5

DRIVER'S LICENSE INFORMATION

Employee Certifications and training Information

By signing this you certify that you have read and understood information above.

CONTACT US

INCIDENT	CITY/STATE	CHARGE

NAME	ADDRESS/PHONE	YEARS KNOWN/RELATIONSHIP

Type of Medication	Purpose	Side Effects

Received Cert/License As:	Date Issued:	Cert/License #: