Job Application Form

Job Application
Your Name*

First NameLast Name
Your Social Security*
Your Drivers License Number (Please Fill Out if Requesting a Driver Role)
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Email*
example@example.com
Are you 18 years old or older?*

YesNo
Are you a US citizen or an alien authorized to work in the US?*

YesNo
Have you been convicted of a felony now or in the past?*

YesNo
Type of Work Desired*

Full TimePart Time
Salary Desired*
What Position are you Interested In?*
What Date can You Start?*

MonthDayYear
Date
Are you currently employed?*

YesNo
If so, may we contact this employer?*

YesNo
Have you ever worked for Atlas Van Lines, Imlach Movers, or Imlach Group before?

YesNo
Are you able to work days and/or nights?

DaysNights
Do you have dependable transportation?*

YesNo
What is the highest level of education you have completed?*

Elementary SchoolHigh School DiplomaAssociate's DegreeBachelor's DegreeMaster's DegreeDoctoral Degree
Name of Last Employer*
Last Employer Address (City/State Required)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date of Last Employment

MonthDayYear
Date
End Date of Last Employment

MonthDayYear
Date
Description of previous work for last employer:
Can we contact your last supervisor?

YesNo
Name of Last Supervisor

First NameLast Name
Phone Number of Last Supervisor
Please enter a valid phone number.Format: (000) 000-0000.
Reason for leaving last employer?
List All Applicable Licenses (e.g. Class A CDL, Chauffeur's License, etc.)
Name and Address of Emergency Contact
Have you reviewed the job description for which you are applying?*

YesNo
Can you fulfill all job functions required?*

YesNo
Resume*

Cancelof
Cover Letter (Optional)

Cancelof
Should be Empty: