Employment Application
Date *
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Last Name *
Your answer
First Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Position Applied For
Your answer
Date Available *
MM
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DD
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YYYY
How were you referred to us for employment? *
Are you a citizen of the United States? *
Are you authorized to work in the US? *
Have you ever worked for this company? *
If yes, when did you work for this company?
MM
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DD
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YYYY
Have you ever been convicted of a felony? *
If yes, please explain
Your answer
Military Service
Your answer
Educational History *
Your answer
Employment History *
Your answer
We typically schedule interviews Tues-Fri from 2-5. What days/times would you be available? *
Your answer
References
Please give three references
Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Company *
Your answer
Address *
Your answer
Reference Two
Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Company *
Your answer
Address *
Your answer
Reference Three
Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Company *
Your answer
Address *
Your answer
It is the policy of LJPS Inc to recruit, hire, and promote qualified applicants and to provide equal employment opportunities to all applicants in a manner which will not discriminate against any person because of race, color, religion, national origin, sex, age, or disability. I understand that this application or the granting of an interview does not create a contract of employment. I certify that the statements herein are true and that falsification or willful omission shall be sufficient cause for dismissal or refusal of employment. I also understand that to be employed, I must be authorized to work in the United States and must provide documents as proof. I authorize the company to investigate thoroughly my work and personal history and verify all data given to the company. In return for being considered for all positions, I release the company from any liability which might arise from such an investigation. I authorize them from all liability for damage in providing this information *
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