ATI Employment Application

Application for Employment
Date

MonthDayYear
Personal Information
Name*

First NameLast Name
Address*

Address

Street Address Line 2

CityState

Zip
Phone Number*
Email Address*
example@example.com
Are you 18 years or older?*

YesNo
Are you legally authorized to work in the United States?*

YesNo
If no, please explain:*

Criminal History Disclosure
Employment offers at ATI are contingent upon a clear background check that complies with various state requirements. While a conviction does not automatically disqualify an applicant, factors such as the nature of the offense, the time elapsed, and its relevance to the position are carefully considered. However, convictions of barrier crimes, as defined by the Commonwealth of Virginia, will result in disqualification from employment.
Have you ever been convicted of a felony?*

YesNo
If yes, please explain:*
Driving Record Disclosure
Employment offers at ATI are contingent upon a driving record review that meets the standards set by our insurance carrier. This review ensures compliance with safe driving practices and eligibility for the position.
Do you currently hold a valid and unrestricted driver's license?*

YesNo
Have you been a licensed driver for at least 3 years?*

YesNo
Which state issued your driver's license? *
Applicants with a Virginia driver’s license must have an official driving record reviewed through the Virginia DMV. ATI will conduct this pre-employment check at no cost to you. The results will remain confidential but will become part of your employment record. Employment at ATI is contingent upon maintaining continual safe driving practices and meeting the standards required by our insurance carrier.

By entering your infomation and signing below, you give consent for ATI to complete this review.
Last Name*
VA Driver's License #*
Signature*

Clear
Applicants with an out-of-state driver’s license must provide an official driving record from their state’s DMV. Employment with ATI is contingent upon a review of your driving record and ensuring it meets safe driving standards as required by our insurance carrier.

You will receive an email after submitting your application with further details on how to submit proof of your driving record.

Employment Desired
Position*
Available Start Date*

MonthDayYear
Date
Desired Pay*
Hourly Rate//Salary
Referred By*
Are you currently employed?*

YesNo
If yes, may we contact your current employer?*

YesNo
Have you ever applied with ATI before?*

YesNo
If yes, please indicate when*

Education
School Name*
Location*
Years Attended *
Did you graduate?*
Major/Subjects Studied*
School Name
Location
Years Attended
Did you graduate?
Major/Subjects Studied
School Name
Location
Years Attended
Did you graduate?
Major/Subjects Studied

Former Employment

List previous three employers, starting with the most recent first
Date (From)*
Month & Year
Date (To)*
Month & Year
Name and Address of Employer*
Salary/Pay Rate*
Position*
Reason For Leaving*
Date (From)*
Month & Year
Date (To)*
Month & Year
Name and Address of Employer*
Salary/Pay Rate*
Position*
Reason For Leaving*
Date (From)
Month & Year
Date (To)
MM/YYY
Name and Address of Employer
Salary/Pay Rate
Position
Reason For Leaving
Which of these jobs did you like the best?*
What did you like most about this job?*

Professional References

Give the names of three persons not related to you, whom you have known at least one year. Include 2 current or past employers or supervisors and one other professional reference
Name*
Company & Title*
Email*
example@example.com
Phone*
Please enter a valid phone number.
Name*
Company & Title*
Email*
example@example.com
Phone*
Please enter a valid phone number.
Name*
Company & Title*
Email*
example@example.com
Phone*
Please enter a valid phone number.
By signing below, I confirm that all information provided in this application, including any supporting documents, is true, accurate, and complete. I understand that any misrepresentation, falsification, or omission of information may result in disqualification from employment consideration. If discovered after employment begins, such actions may lead to immediate termination. Furthermore, I acknowledge that any employment offer or acceptance with ATI is at-will and may be terminated at any time by either party, with or without cause.
Signature*

Clear

Applicant Information Release
I hereby authorize any person, educational institution, or company listed as a reference on my employment application to disclose, in good faith, information regarding my qualifications and suitability for employment.

By signing below, I release ATI, my former employers, educational institutions, and any other individuals or entities providing references from liability related to the exchange of this information and any other reasonable and necessary information relevant to the employment process.
Name*
Signature*

Clear
Should be Empty:

Application for Employment

Personal Information

Criminal History Disclosure

Driving Record Disclosure

Employment Desired

Education

Former Employment

Professional References

Applicant Information Release