Employment Application

Referred by:

Job Position you are applying for: *

PERSONAL INFORMATION

Telephone No. Residence:

Cell No.: *

Email Address: *

First Name: *

Middle Name:

Last Name: *

Do you have reliable transportation?

Do you possess a valid driver's license? *

Present Address:

Street No.: *

City: *

State: *

Zip Code: *

Previous Address:

Street No.:

City:

State:

Zip Code:

Permanent Address:

Street No.:

City:

State:

Zip Code:

EMPLOYMENT DESIRED

Date you will be available for work?

Salary Desired $:

Are you currently employed?

If so, may we contact your employer?

If you have applied to this company before, please indicate when and position.

Do you have any relatives employed by this company?

If so, please list names.

If you have worked for this company before, please indicate when and position held.

Do you seek full- or part-time employment? *

List other names or aliases you have used.

If employed, can you provide proof of legal right to work in the United States? *

If no, please explain.

Skills, abilities, qualifications, or experiences which you feel would fit you to work for Atkinson Baker:

Do you type?

If yes, how many WPM?

Do you have or anticipate any obligations which could conflict with a standard work schedule or performance of assigned duties? *

If yes, describe.

EDUCATION HISTORY

Languages Spoken:

Last Elementary School Attended:

Name:

City:

State:

Grade Completed:

Last High School Attended:

Name:

City:

State:

Grade Completed:

Junior College Attended:

Name:

City:

State:

Year Completed:

Major:

Minor:

College or University Attended:

Name:

City:

State:

Year Completed:

Major:

Minor:

Graduate School Attended:

Name:

City:

State:

Year Completed:

Major:

Minor:

Trade School Attended:

Name:

City:

State:

Year Completed:

Major:

Minor:

Adult Education or Special Training:

PROFESSIONAL REFERENCES

Please list three professional references you have known for at least one year:

1. Name:

Relationship:

Years Known:

Address:

Telephone:

2. Name:

Relationship:

Years Known:

Address:

Telephone:

3. Name:

Relationship:

Years Known:

Address:

Telephone:

In case of emergency, who should we notify?

Name

Relationship

Street No.:

City:

State:

Zip Code:

Telephone:

EMPLOYMENT HISTORY

Please fill out all fields, "see resume" will not be accepted.

List your present or last position.

Company Name: *

Address: *

Phone: *

Name/Title of Supervisor *

Job Title: *

Dates of Employment (Month/Year) *

From: *

To: *

Type of work performed: *

Reason for Leaving: *

List your previous position.

Company Name:

Address:

Phone:

Name/Title of Supervisor

Job Title:

Dates of Employment (Month/Year)

From:

To:

Type of work performed:

Reason for Leaving:

List your previous position.

Company Name:

Address:

Phone:

Name/Title of Supervisor

Job Title:

Dates of Employment (Month/Year)

From:

To:

Type of work performed:

Reason for Leaving:

Please explain any gap in employment history above.

Please explain any work-related accomplishments you are especially proud of.

Hobbies, recreation, Special Interests:

Today's Date: *

Please Upload Your Resume:

Maximum upload size: 8.39MB

READ STATEMENTS BELOW CAREFULLY BEFORE AGREEING

I certify that the answers given herein are true and complete to the best of my knowledge. I agree that any misrepresentation, false statement, or omission made by me with respect to the information contained in this application or interview(s) shall be sufficient cause to disqualify me from consideration, or, if hired, to terminate my employment.

I agree to have any of the statements herein as well as my background investigated by Atkinson-Baker, Inc., or its agents. I understand that the background investigation may include, but is not limited to, reviewing my education, employment history, credit history, any public records, and personal references. In consideration for reviewing my application and other related information, I hereby waive and release Atkinson-Baker, Inc., its employees and agents, and all other entities and persons, and their respective employees and agents, from any claims I might have, including defamation and invasion of privacy, arising out of any verbal or written inquiries and/or any verbal or written responses related to investigation of my background as well as the use or disclosure of such information.

I acknowledge and agree that in order to enable the Company to determine whether I possess the skills and other personal qualities necessary to qualify for the position I am applying for, the Company may engage in a testing and interview process which includes reading a full job description. The tests may include but not be limited to those that measure intelligence, aptitude, and personality traits required to meet the requirements of the position, including but not limited to meeting the Company's standards for performance, interpersonal relations, and competence on the job. Accordingly, I hereby release the Company (Atkinson-Baker, Inc., and Master Tech) and any and all Company officers, stock holders, employees, representatives, agents, licensees, licensors, subsidiaries, parent corporations associated with testing services and any and all other related individuals, corporations, partnerships and organization from any and all claims, demands, suits and/or liabilities -- including but not limited to claims based on any state or federal rights of privacy -- arising from or in any way related to such testing and interview processes.

I understand that nothing contained in this pre-employment application or in the granting of an interview is intended to create an employment agreement. I also understand that the completion of this pre-employment application does not indicate there are open positions and does not obligate Atkinson-Baker, Inc., in any way.

I agree that, if employed, I will abide by all policies and procedures established by Atkinson-Baker, Inc. I understand that my employment is "at will," that I may resign at any time, that Atkinson-Baker, Inc., may terminate my employment at any time, with or without cause, and that no employee or other representative of Atkinson-Baker, Inc., has the authority to make an agreement contrary to the foregoing unless it is in writing AND signed by the CEO of Atkinson-Baker, Inc. This constitutes my entire agreement with Atkinson-Baker, Inc., with regard to the matters set forth in this paragraph.

I further recognize that employment is subject to:

* Receiving satisfactory reports from all references solicited.
* Approval of the management of Atkinson-Baker, Inc., in which employment may be offered.

I also recognize that I will be required to:

* Supply a record of birth, U.S. citizenship, or visa status, as appropriate,
* Sign statements dealing with our policy on Conflict of Interest, Confidential Information, Drugs, Harassment, and certain other employment forms.

It is understood that if, after I have submitted this application to Atkinson-Baker, Inc., any changes occur which affect the accuracy of the information entered herein, it shall be my responsibility to inform Atkinson-Baker, Inc. of such changes prior to accepting employment.

As you may know, in order to assist us in running a smooth and cohesive company, we apply the management, administrative and business ethics systems developed by American philosopher L. Ron Hubbard. These administrative systems deal with business topics such as communication, organization, administration, marketing, promotion, business ethics and finance. While Mr. Hubbard is the founder of the Scientology religion, these management and administrative systems are non-religious and can be used by anyone without a requirement that the person change his or her religious or other beliefs. Indeed, the company is an equal opportunity employer and does not discriminate in hiring or the terms and conditions of employment based on a person’s race, religion, sex, national origin, age, disability, or other characteristic protected by applicable law. It has been our experience that by using and applying this business model we can expand our company, provide excellent service to our clients, and flourish and prosper in today’s challenging business environment.

As part of our management philosophy, we expect each employee to take full responsibility for the products produced by his or her job and for the services he or she delivers, both to our clients and to other internal staff.