A-Line T.D.S. Employment Application

Name *

FIRST NAME MIDDLE NAME LAST NAME

SOCIAL SECURITY NUMBER *

STREET ADDRESS *

UNIT NO. (if applicable)

CITY *

STATE *

ZIP CODE *

GENDER *

MALE FEMALE

PHONE NUMBER *

EMAIL ADDRESS *

example@example.com

POSITION APPLYING FOR *

DESIRED SALARY (optional)

DESIRED EMPLOYMENT (optional)

FULL TIME PART TIME

DATE AVAILABLE TO START

Date

REFERRED BY

SHIFT AVAILABLE TO WORK (select all that apply)

1st Shift 2nd Shift 3rd Shift

Are you authorized to work in the United States? *

Yes No

Are you 18 years or older? *

Yes No

Are you willing to travel and work out of town? *

Yes No

Do you have a Drivers License? *

Yes No

If yes, what type?

Do you have any physical condition which may limit your ability to perform the position applied for? *

Yes No

If yes, please explain.

NAME OF HIGH SCHOOL *

MAJOR/EMPHASIS *

DID YOU GRADUATE? *

Yes No

NAME OF COLLEGE

MAJOR/EMPHASIS

DID YOU GRADUATE?

Yes No

OTHER

i.e. Trade school or Business school

MAJOR/EMPHASIS

DID YOU GRADUATE?

Yes No

EMPLOYMENT HISTORY (most recent experiences)

MOST RECENT EMPLOYER *

JOB TITLE *

SUPERVISOR *

START DATE *

Date

END DATE *

Date

EMPLOYER PHONE NUMBER *

REASON FOR LEAVING *

SECOND MOST RECENT EMPLOYER *

JOB TITLE *

SUPERVISOR *

START DATE *

Date

END DATE *

Date

EMPLOYER PHONE NUMBER *

REASON FOR LEAVING *

THIRD MOST RECENT EMPLOYER *

If none, please write "N/A"

JOB TITLE

SUPERVISOR

START DATE

Date

END DATE

Date

EMPLOYER PHONE NUMBER

REASON FOR LEAVING

A-Line T.D.S. is an Equal Opportunity Employer. We comply with all applicable state and federal civil rights and equal employment laws and regulations.

EQUIPMENT OPERATED (if applicable)

LOCATION OPERATED (if applicable)

YEARS OF EXPERIENCE (if applicable)

EQUIPMENT OPERATED (if applicable)

LOCATION OPERATED (if applicable)

YEARS OF EXPERIENCE (if applicable)

EQUIPMENT OPERATED (if applicable)

LOCATION OPERATED (if applicable)

YEARS OF EXPERIENCE (if applicable)

REFERENCES (Please list 3 who are not relatives)

REFERENCE 1 - NAME *

First and Last

RELATIONSHIP *

EMAIL ADDRESS

PHONE NUMBER *

REFERENCE 2 - NAME *

First and Last

RELATIONSHIP *

EMAIL ADDRESS

example@example.com

PHONE NUMBER *

REFERENCE 3 - NAME *

First and Last

RELATIONSHIP *

EMAIL ADDRESS

example@example.com

PHONE NUMBER *

Please upload your resume (optional)

IMPORTANT - Please read the following statement carefully before you sign and submit this application.

I understand that employment may be conditioned upon successfully passing a background check and that I may be required to satisfactorily complete a drug screening as a condition of employment.

I understand that my employment is at-will and that I may terminate the employment relationship at any time and for any reason, with or without notice, and that the company has the same right.

If I am hired, I agree to report any instance to A-Line T.D.S. if I am convicted of a criminal offense.

If I am hired, I agree to and authorize the use of direct deposit for payment of wages.

I hereby authorize persons, schools, my current employer (if applicable) and previous employers or other organizations to provide A-Line T.D.S. and its affiliates with any requested information regarding my application or suitability for employment. I completely release all such persons or entities from any and all liability related to the providing or use of such information.

I hereby affirm that the information provided on this application (and accompanying resume, if applicable) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge if discovered at a later date.

PRINTED NAME *

SIGNATURE *

Clear

DATE *

Date

Employment Application

APPLICANT INFORMATION

EDUCATION

SKILLS AND LICENSES