Position Applied for*

Are you authorized to work in the U.S.?*
YesNo

Have you ever worked for this company?*
YesNo

If yes, when?*

Have you ever been convicted of a felony?*
YesNo

If yes, explain*

*A felony conviction does not necessary preclude you from employment at Atlantic Lift Systems.

High School

Did you graduate?*
YesNo

College

Did you graduate?*
YesNo

Other

Did you graduate?
YesNo

References

Please list three professional references.

Previous Employment

May we contact your previous supervisor for a reference?*
YesNo

May we contact your previous supervisor for a reference?*
YesNo

May we contact your previous supervisor for a reference?*
YesNo

Military Service

If other than honorable, explain

I, , acknowledge Atlantic Lift System’s requirement to provide an authorized DMV driving record,
dated within the last month, prior to employment. Official offer of employment will be dependent on results of driving record.

List all driver licenses or permits held in the past 3 years

License Type State of Certification License Number Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
YesNo

B. Has any license, permit or privilege ever been suspended or revoked?*
YesNo

If the answer to A or B is yes, please explain.

Drug Testing and Background Check Requirements

Atlantic Lift Systems is a drug-free workplace. As such, we prohibit the use of non-prescription drugs or alcohol during work hours. If the employee comes to work under the influence of drugs or alcohol or uses drugs or alcohol during work time, the employee will be disciplined in accordance to the policy up to and including termination.

Under Atlantic Lift System’s drug testing policy, all current and prospective employees must submit to the drug testing policy. Prospective employees will only be asked to submit to a test once a conditional offer of employment has been extended and accepted. An offer of employment by Atlantic Lift Systems is conditioned on the prospective employee testing negative for illegal substances.

Atlantic Lift System’s policy is intended to comply with all state laws governing drug testing and is designed to safeguard employee privacy rights to the fullest extent of the law.

Before being asked to submit to a drug test, the employee will receive written notice of the request or requirements. The employee must also sign a testing authorization and acknowledgement form confirming that he or she is aware of the policy and employee rights.

Any drug testing required or requested by Atlantic Lift Systems will be conducted by a laboratory licensed by the state. All expenses related to the test will be incurred by the company. The employee may obtain the name and location of the laboratory that will analyze the employee's test prior to testing. Testing laboratory will be noted below along with contact and location information.

If the employee receives notice that the test results were confirmed positive, the employee will be given the opportunity to explain the positive result. In addition, the employee may have the same sample retested at a laboratory of the employee's choice.

If there is reason to suspect that the employee is working while under the influence of an illegal drug or alcohol, the employee will be suspended [with or without] pay until the results of a drug and alcohol test are made available to Atlantic Lift Systems by the testing laboratory. Where drug or alcohol testing is part of a routine physical or random screening, there will be no adverse employment action taken until the test results are in. All testing results will remain confidential. Employee must sign a consent form prior to the release of results. Test results may be used in arbitration, administrative hearings and court cases arising as a result of the employee's drug testing. Results will be sent to federal agencies as required by federal law. If the employee is to be referred to a treatment facility for evaluation, the employee's test results will also be made available to the employee's counselor.

Confidential Background Check Authorization

Print Name*

Current Address Since

Previous Address Since

Previous Address Since

The Information contained in this application is correct to the best of my knowledge.

I hereby authorize and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number, credit reports, current and previous residences, employment history, education background, character references, drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and date of birth.

Physical Requirements

Can you climb a 10’ ladder or higher?*
YesNo

Can you lift over 50 lbs.?*
YesNo

Can you perform work that requires bending, twisting and reaching?*
YesNo

Do you have any vision or hearing impairments that would affect your ability to fully perform all of the job responsibilities of the position for which you are applying?*
YesNo

If yes to the above, please explain.

Do you have any physical conditions that would affect your ability to fully perform all of the job responsibilities of the position for which you are applying?*
YesNo

If yes to the above, please explain.

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