Online Application
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Atlantic States Cast Iron Pipe Company
183 Sitgreaves Street, Phillipsburg, NJ 08865

APPLICATION FOR EMPLOYMENT

Atlantic States is an Equal Opportunity Employer. It is our affirmative policy not to unlawfully discriminate against any employee or applicant for employment on the basis of race, color, religion, national orgin, sex, sexual orientation, marital status, age, physical or mental disability or status as a special disabled veteran or veteran of the Vietnam era.

Please print clearly. Fill in all sections as accurately as possible. If employed, this document becomes part of your permanent records. Application expires in 3 months.

 

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Date:      Position applying for:     Date can start:
Full Name:
Full Address:
How long at this address?     Social Security #:
Phone Number:      Alternate Phone Number:
Are you legally authorized to work in the US ? YES NO
Have you ever applied for work at Atlantic States? YES NO    If yes, when:
Have you ever worked for Atlantic States? YES NO    If yes, when:
Have you ever been terminated for misconduct or unsatisfactory job performance: YES NO 
If yes, name of employer :

Have you ever been convicted of a criminal offense? YES NO 
If yes explain, giving nature of offense, place and disposition. The fact that you have a record of conviction will not necessarily disqualify you for employment. The company will consider the age and nature of the offense, as well as any other relevant information.

Referred to Atlantic States by: Friend     Newspaper     Word of mouth

List acquaintances working for Atlantic States:


EDUCATION AND TRAINING
 Name and Location of High School last attended:

Graduated? YES NO 

Name and Location of Vocational, Technical, Jr. College:

Graduated? YES NO 

Name and Location of Colleges or Universities:

Graduated? YES NO 

Name and Location of Other Training or Equivalency Diplomas::

Graduated? YES NO 
Special Skills or Training (Applicable to Employment)

MILITARY SERVICE
Have you ever served in the US Military? YES NO 
If yes, the type of discharge:

PERSONAL REFERENCES
Name: Phone:

List only persons we may contact.

 


EMPLOYMENT RECORD
Give a complete account of your full time employment. Begin with your present or most recent employer.
Employer Name:      Dates of employment:
Last position held:     Rate of pay:
Employer Full Address:
Telephone:      Name of Supervisor:

Reason for leaving:
Were you ever suspended? YES NO    If yes, why:
Were you ever disciplined? YES NO    If yes, why:
 
Employer Name:      Dates of employment:
Last position held:     Rate of pay:
Employer Full Address:
Telephone:      Name of Supervisor:

Reason for leaving:
Were you ever suspended? YES NO    If yes, why:
Were you ever disciplined? YES NO    If yes, why:
 
 
Employer Name:      Dates of employment:
Last position held:     Rate of pay:
Employer Full Address:
Telephone:      Name of Supervisor:

Reason for leaving:
Were you ever suspended? YES NO    If yes, why:
Were you ever disciplined? YES NO    If yes, why:
 
 
May we contact your present employer? YES NO
May we contact your current employer? YES NO

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