Previous Employment Please list your last 3 employers starting with most recent. Employer No. 1: * Please list Business Name Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number: * (###) ### #### Supervisor: * First Name Last Name Job Title: * Start Date: * MM DD YYYY End Date: * MM DD YYYY Starting Salary: * $ Ending Salary: * $ Reson for Leaving: * Layoff Discharge Resign Still Employed May we contact this supervisor for a reference? * Yes No Employer No. 2: * Please list Business Name Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number: * (###) ### #### Supervisor: * First Name Last Name Job Title: * Start Date: * MM DD YYYY End Date: * MM DD YYYY Starting Salary: * $ Ending Salary: * $ Reason for Leaving: * Layoff Discharge Resign Still Employed May we contact this supervisor for a reference? * Yes No Employer No. 3: * Please list Business Name Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number: * (###) ### #### Supervisor: * First Name Last Name Job Title: * Start Date: * MM DD YYYY End Date: * MM DD YYYY Starting Salary: * $ Ending Salary: * $ Reason for Leaving: * Layoff Dicharge Resign Still Employed May we contact this supervisor for a reference? * Yes No Applicant's Statement and Acknowledgement: • I certify that this application was completed by me and that all of the information furnished on this application and during the application process is true, complete, and correct to the best of my knowledge. • I understand that any misrepresentation or omission of facts called for on this application or during the application process may result in termination of the application process or my dismissal from employment at any time regardless of when the false answer or omission is discovered. • I authorize the Company to conduct any necessary investigations or inquiries regarding my background to the extent permitted by federal, state and local law. I agree to complete the requisite authorization forms for the background investigation, if need be. I hereby release all parties from any liability in connection with the provision and use of such information. • I understand that if offered employment, I am to abide by all rules and regulations of the Company. • I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that ither the Company or I may end the employment relationship at any time with or without cause. • I understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company. • I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer. • I consent to all of the following pre-employment processes, which are required by the Company, and I further understand that the offer of employment is contingent upon my successfully completing all of pre-employment testing: • Motor Vehicle Report (MVR) (review of past driving record) • Drug Screen (DOT and Non-DOT applicants) • Previous Employer Drug and Alcohol History (49 U.S.C. §§ 40113, 44702, 44703, 44709, 49 CFR Part 40.25) • Physical Examination and Functional Capacity Evaluation (consistent with federal and state law) • Background Check • I agree and understand that this application for employment in no way obligates the Company to employ me. Read and Acknowledged: * Yes Signature: * E-Sign with Full Printed Name and Date of Birth Today's Date: * MM DD YYYY Thank you for your interest in employment at Atlas Marine Services. Please submit of copy of your current MMC, TWIC, and Driver’s License to hr@atlasmarinellc.com.Someone from our office will be in contact. Thank you!
