Are you at least 18 years old? *

Yes

No

Are you a citizen of the United States? *

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for Atlas Marine Services? *

Yes

No

If yes, when?

MM

DD

YYYY

Have you ever filled an application with us? *

Yes

No

If yes, when?

MM

DD

YYYY

Are you currently employed? *

Yes

No

If yes, may we contact your present employer? *

Yes

No

Do you have a valid Driver's License? *

Yes

No

Have you ever been convicted of a felony or misdemeanor charges? *

Yes

No

Have you had a D.W.I. in the last 3 years? *

Yes

No

Have you had more than 2 moving violations in the past 3 years? *

Yes

No

Are you currently on probation or have any charges pending? *

Yes

No

Can you pass a Drug & Alcohol screening? *

Yes

No

Can you pass all aspects of a U.S. Coast Guard physical examination? *

Yes

No

Emergency Contact: *

First Name

Last Name

Phone Number: *

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