APPLICANT INFORMATION

First Name *

Middle Initial *

Last Name *

Street Address *

Apartment / Unit #

City *

State *

Zip Code *

Today's Date *

Phone *

Email *

Position Applied For *

How Many Hours? *

Pay Rate Expected? *

Date of Birth *

Social Security # *

License #

Have you ever worked for this Company? *

If Yes, what dates ? *

Are you legally able to be employed in the U.S.? *

Yes

No

May we contact your present or past employers? *

Yes

No

Have you ever been convicted of felony? *

Yes

No

If yes, please explain: *

PREVIOUS EMPLOYMENT

Company *

Phone *

Address *

Supervisor *

Job Title *

Starting Salary $

Ending Salary $

Responsibilities *

From *

To *

Reason for leaving *

May we contact your previous supervisor for a reference? *

Yes

No

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

No

Summarize special job-related skills & qualifications acquired from employment or other experience not noted in employment history (if applicable): *

MILITARY

Branch

From

To

Rank of Discharge

Type of Discharge

If other then honorable, explain

OFFICE QUALIFICATIONS

What computer skills do you have and what are you comfortable using? *

Microsoft Office *

Additional Comments

Google Suite *

Additional Comments

Soft-Pak (ERP) *

Additional Comments

Word *

Additional Comments

Excel *

Additional Comments

PowerPoint *

Additional Comments

Are you a fast typer? *

Are you comfortable and experienced using a phone with multiple lines? *

Are you comfortable and experienced handling a high volume of telephone calls? *

Are you comfortable and experienced with data entry with a high-level of accuracy? *

Describe any specialized training, apprenticeship, skills & other activities that would be of importance to the position: *

DISCLAIMER AND SIGNATURE

I certify that the answers given herein are true and complete to the best of my knowledge.
I hereby authorize LePage & Sons to investigate all statements contained in this application for employment and I release any party from claims based upon their providing information to LePage & Sons.
I hereby authorize LePage & Sons to conduct a criminal background search and any further investigations deemed necessary by LePage & Sons.
I authorize LePage & Sons to verify references and make other inquiries concerning any and all background information provided herein.
I hereby waive any and all claims arising out of LePage & Sons’ investigation of my background.
I understand and agree that any employment relationship with LePage & Sons is of an “at will” nature, which means that I may resign at any time and LePage & Sons may discharge me at any time with or without cause and with or without prior notice. It is further understood that this “at will” employment relationship may not be changed by verbal statement, written document, or by conduct unless such change is specifically acknowledged in writing by an authorized agent of LePage & Sons.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Signature *

Clear

Today's Date *

How did you hear about us?

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OFFICE QUALIFICATIONS

DISCLAIMER AND SIGNATURE

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