Atlantis Industries -DE | Precision Custom Injection Molder

Previous Employer #1
Please fill out the details for your most recent employer.
Company Name*
Beginning Date*
Date Format: MM slash DD slash YYYY
Ending Date*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Starting Wage
Ending Wage
Work Performed
Reason For Leaving
Supervisor's Name*
First Last
Phone*

Previous Employer #2
Please fill out the details for your second most recent employer.
Company Name*
Beginning Date*
Date Format: MM slash DD slash YYYY
Ending Date*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Starting Wage
Ending Wage
Work Performed
Reason For Leaving
Supervisor's Name*
First Last
Phone*
Previous Employer #3
Please fill out the details for your third most recent employer.
Company Name*
Beginning Date*
Date Format: MM slash DD slash YYYY
Ending Date*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title*
Starting Wage
Ending Wage
Work Performed
Reason For Leaving
Supervisor's Name*
First Last
Phone*

Additional Information - Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience
Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied?*
- Yes
- No
References
Please list at least 3
List*
Name Phone Years Known Relationship to Applicant

Review & Sign
{all_fields}
By submitting this form I agree with all of the following
:
- I hereby give permission to contact the employers listed previously concerning my prior work conduct and experience.
- I certify that the answers given here are true and complete to the best of my knowledge.
- I authorize investigation of all statement contained in this application for employment as may be necessary in arriving at the employment decision.
- This application for work shall be considered active for a period not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of this employer.
- I also understand by filling out and submitting this form it does not guarantee employment.
- I am aware that if the application process proceeds I will be required to supply Atlantis Industries with my social security number for work eligibility verification purposes before I will be given any work to complete.
Electronic Signature
First Last
For Internal Use Only
Schedule for Interview
- Yes
- No
Interviewer
Date of Interview
Date Format: MM slash DD slash YYYY
Interview Remarks
Call for Second Interview
- Yes
- No
Interviewer
Date of Interview
Date Format: MM slash DD slash YYYY
Interview #2 Remarks
Hired
- Yes
- No
Date of Hire
Date Format: MM slash DD slash YYYY
Job Title
Hourly Rate of Pay
Notes

Careers-Application

Interested in working with us?
Complete & Submit the form below, and we will get back to you!

Step 1 of 5

Personal Information

Previous Employer #1

Previous Employer #2

Previous Employer #3

Additional Information - Other Qualifications

References

Review & Sign

For Internal Use Only

Services

Markets

Resin Types

Name	Phone	Years Known	Relationship to Applicant

Careers-Application

Interested in working with us? Complete & Submit the form below, and we will get back to you!

Step 1 of 5

Personal Information

Previous Employer #1

Previous Employer #2

Previous Employer #3

Additional Information - Other Qualifications

References

Review & Sign

For Internal Use Only

Services

Markets

Resin Types

Interested in working with us?
Complete & Submit the form below, and we will get back to you!