APPLICATION FOR EMPLOYMENT

Prospective employees will receive consideration without discrimination because of race, religion, creed, color, gender, age, national origin, disability, sexual orientation, marital or any other legally protected status.

Page 1 of 12

PERSONAL

Application For Employment
  1. Last Name(*)
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  2. First Name(*)
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  3. Middle
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  4. Email Address(*)
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  5. Street Address
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  6. City
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  7. State
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  8. Zip Code
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  9. Home Phone
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  10. Business Phone
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  11. Have you ever applied for employment with us?
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  12. If yes, Month and Year:
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  13. Previous Application Location
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  14. Are you presently employed?
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  15. Apart from absence for religious observance, are you available for full-time work?
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  16. If not, what hours can you work?
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  17. Will you work overtime if asked?
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  18. Are you legally eligible for employment in the U.S.?
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  19. When will you be available to begin work?
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  20. Position
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  21. Are you currently on lay-off status and subject to recall?
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  22. How did you learn of our organization?
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  23.  
  1. COLLEGE

  2. College Name/Location of School
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  3. No. of years completed
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  4. Did you graduate?
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  5. College Degree or Majors
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  6. HIGH SCHOOL

  7. High School Name/Location of School
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  8. No. of years completed
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  9. Did you graduate?
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  10. High School Degree or Majors
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  11. TECHNICAL

  12. Technical Name/Location of School
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  13. No. of years completed
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  14. Did you graduate?
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  15. Technical Degree or Majors
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  16. OTHER

  17. Other Name/Location of School
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  18. No. of years completed
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  19. Did you graduate?
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  20. Other Degree or Majors
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  21.  
  1. Are you presently in the Reserves or National Guard?
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  2. Have you served in the Military?
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  3. Describe your duties and any special training.
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  4.  
  1. What was your previous address?
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  2. How long at your previous address?
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  3. Are you over 18 years of age?
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  4. How long at present address?
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  5. Have you ever been bonded?
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  6. If yes with what employers?
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  7. Have you ever been convicted of a felony?
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  8. If yes, describe in full:
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  9. State names of relatives and friends working for us other than your spouse.
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  10.  
  1. Reference One

  2. Name
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  3. Address
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  4. Phone Number
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  5. Reference Two

  6. Name
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  7. Address
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  8. Phone Number
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  9. Reference Three

  10. Name
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  11. Address
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  12. Phone Number
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  13. Reference Other

  14. Name
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  15. Address
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  16. Phone Number
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  17.  
  1. Membership in Professional or Civic Organizations (Exclude those, which may disclose your race, color, religion, or natural origin)
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  2.  
  1. Company Name
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  2. Address
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  3. Name of Supervisor
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  4. State Job Title and Job Description
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  5. Telephone
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  6. Employed From (Month/Year)
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  7. Employed To (Month/Year)
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  8. Hourly Rate / Salary Start:
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  9. Hourly Rate / Salary End:
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  10. Reason for Leaving:
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  11.  
  1. Company Name
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  2. Address
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  3. Name of Supervisor
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  4. State Job Title and Job Description
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  5. Telephone
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  6. Employed From (Month/Year)
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  7. Employed To (Month/Year)
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  8. Hourly Rate / Salary Start:
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  9. Hourly Rate / Salary End:
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  10. Reason for Leaving:
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  11.  
  1. Company Name
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  2. Address
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  3. Name of Supervisor
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  4. State Job Title and Job Description
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  5. Telephone
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  6. Employed From (Month/Year)
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  7. Employed To (Month/Year)
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  8. Hourly Rate / Salary Start:
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  9. Hourly Rate / Salary End:
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  10. Reason for Leaving:
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  11.  
  1. Company Name
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  2. Address
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  3. Name of Supervisor
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  4. State Job Title and Job Description
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  5. Telephone
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  6. Employed From (Month/Year)
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  7. Employed To (Month/Year)
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  8. Hourly Rate / Salary Start:
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  9. Hourly Rate / Salary End:
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  10. Reason for Leaving:
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  11.  
  1. Company Name
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  2. Address
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  3. Name of Supervisor
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  4. State Job Title and Job Description
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  5. Telephone
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  6. Employed From (Month/Year)
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  7. Employed To (Month/Year)
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  8. Hourly Rate / Salary Start:
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  9. Hourly Rate / Salary End:
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  10. Reason for Leaving:
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  11. We may contact the employers listed above unless you indicate those you do not want us to contact. Do not Contact the following:
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  12.  
  1. The information provided in the Application for Employment is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in dismissal.

    I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

    If you decide to engage an investigative consumer-reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name and address of the agency so I may obtain from them the nature and substance of information contained in the report.

    LMI recognizes its rights to establish rules and regulation covering the conduct of its employees. This includes the right to hire, to discharge for cause, to promote, to demote, to reassign workstations, to assign duties outside the assigned workstations and to apply disciplinary action.

  2. Signature Date(*)
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  3. Signature(*)
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  4. Captcha
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