2529 Commerce Parkway
North Port, FL 34286-9355

All questions must be answered carefully and completely. Press TAB key to move between fields, Do not press Enter as it will submit the form before you complete it. Click on the SUBMIT button at the bottom of the form when you've completed the form. If you have a resume, please print this application before submitting, attach the resume to it and mail it to the address listed above.

Date (dd/mm/yy):

PERSONAL DATA

Name: EMail Address:
Address:
City: State: Zip Code: Telephone:
Position Desired: Salary Desired: $
Hours Available From: To: Willing to work overtime?YesNo

YesNo Are you legal to work in the U.S.? YesNo Are you over the age of 18?
YesNo Are you able to perform any or all job functions with or without reasonable accommodation? YesNo Have you ever used illegal drugs?
YesNo Have you used illegal drugs in the last 6 months?
YesNo Have you ever been a previous employee?
YesNo Have you ever been a previous applicant?		 YesNo Have you ever been convicted of a felony or pled nolo contendere to a felony? *If yes, describe conditions: *(conviction will not necessarily disqualify an applicant for employment)

WORK EXPERIENCE

Note: Start with the most recent position, furnish dates and explanation for each period of employment and unemployment for the past 10 years.

Previous Employer: Type of Business:
Phone Number: Start Date: Leave Date:
Address:
Rate of Pay: $ WeeklyBi-weeklyMonthlyAnnually
Job Title:
Supervisor Name & Title:
May We Contact? YesNo
Reason for Leaving:
Describe Responsibilities:
Previous Employer: Type of Business:
Phone Number: Start Date: Leave Date:
Address:
Rate of Pay: $ WeeklyBi-weeklyMonthlyAnnually
Job Title:
Supervisor Name & Title:
May We Contact? YesNo
Reason for Leaving:
Describe Responsibilities:
Previous Employer: Type of Business:
Phone Number: Start Date: Leave Date:
Address:
Rate of Pay: $ WeeklyBi-weeklyMonthlyAnnually
Job Title:
Supervisor Name & Title:
May We Contact? YesNo
Reason for Leaving:
Describe Responsibilities:
Previous Employer: Type of Business:
Phone Number: Start Date: Leave Date:
Address:
Rate of Pay: $ WeeklyBi-weeklyMonthlyAnnually
Job Title:
Supervisor Name & Title:
May We Contact? YesNo
Reason for Leaving:
Describe Responsibilities:

EDUCATION AND TRAINING

Type of School Name and Location of School Degree Earned-Diploma? Major/Minor
Fields of Study
HighTrade
BusinessTech
CollegeOther
CollegeOther

REFERENCES

Name Telephone Address Relationship

APPLICANT STATEMENT

PLEASE READ BEFORE SUBMITTING OR SIGNING THS FORM: The facts set forth in my application are true and complete. I authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information. I understand that if employed, false statements, omissions or misleading statements on this application, regardless of the time they are discovered, shall be considered sufficient cause for dismissal. I also agree that my employer shall not be held liable in any respect if my employment is terminated because of such omissions or false misleading statements. The company is hereby authorized to investigate my employment history, including contacting employers listed and to verify my education and training

Please Print a copy of this form before clicking on the submit button below, sign the printed copy and bring it with you to your job interview.

SIGNATURE:_________________________
DATE:_____________________

Click submit if you agree to the terms and conditions listed above in the applicant statement. After clicking submit, a copy of your application will be E-Mailed to ATI and kept on file for 1 year.