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PERSONAL INFORMATION |
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First Name |
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Last Name |
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Middle Initial |
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Social Security Number
(Will be required upon employment)
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Street Address |
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Address (cont.) |
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City |
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State/Province |
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Zip/Postal Code |
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County |
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Work Phone |
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Home Phone |
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FAX |
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E-mail |
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Web Site URL |
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Date of Birth |
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Sex |
Male
Female |
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POSITION |
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What Position are you applying for? |
Auditor/Accounting Associate
Sales |
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How did you hear about this position? |
Newspaper Ad: (Please specify paper):
Direct Contact
Referred By: |
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Are you applying for a full or part time
position? |
Full
Time Part Time |
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When can you start if hired? |
Immediately
One
Month
On
or later than: |
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Salary Requirements ($) |
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WORK HISTORY AND QUALIFICATIONS |
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Are you currently employed |
Yes
No |
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If yes, may we contact your employer? |
Yes
No |
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Have you previously applied to LTC Consulting |
Yes
No |
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Are you willing to work overtime? |
Yes
No |
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Do you have a valid driver's license? |
Yes
No |
Have you even been convicted of a felony?
Note: this question does not apply to
convictions which have been expunged or sealed. (A conviction record will not
necessarily be a bar to employment.) |
Yes
No |
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If
so, please describe fully the criminal conviction(s), listing the nature of the
offense(s) and your rehabilitation since the conviction(s). |
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EDUCATIONAL BACKGROUND |
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Highest level of education |
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Name of School(s) |
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Major Area of Study (if applicable) |
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Special Skills (if applicable) |
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WORK EXPERIENCE |
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Please list your employers
for the last two years, starting with your present or last place of employment
(up to a maximum of four employers). Also include any verifiable work performed
on a volunteer basis, internship or military service. Please list your
current employer first. |
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Mo./Yr |
Name, Address, & Phone No. of Employer |
Salary
(/Yr.) |
Position |
Name of
Supervisor |
Reason
for Leaving |
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From:
To:
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From:
To:
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From:
To:
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From:
To:
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REFERENCES |
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Please
give the names of three additional work-related references we may call. Please
do not list relatives. Individuals with no prior work experience may list
school- or volunteer-related references. |
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Name and Position |
Company Name |
Phone Number |
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1.
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2.
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3.
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APPLICANT'S STATEMENT |
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I agree to
conform to the rules and regulations of the company, and I understand that the
company has complete discretion to modify such rules and regulations at any
time, except that it will not modify its policy of employment at will.
The above
information is complete and true to the best of my knowledge. I understand that
any misrepresentation or omission on my part of the facts in this application
may result in immediate dismissal.
I hereby
authorize you to conduct any investigation necessary concerning any part of my
background related to the position I am seeking. I release all parties from any
liability in connection with the provision and use of such information.
If you come in
for interview, you will be asked to sign a printed copy of this form. |
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I agree: |
Yes
No |
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Type your name to confirm: |
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