Application for Employment

We are an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. This application shall be considered active for a period of time not to exceed 60 days.


Date of application: Saturday, February 04, 2012

Personal

Last name
First name
Middle initial
Street
City
State
Zip *
Home phone
Secondary phone
How did you learn about the company? (check one)
Print Advertisement Radio Advertisement Friend

Current Employee Walk-in Internet
Other
Do you have any relatives or friends who work for the company? (check one)

Yes No
If yes, who and where do they work?
What position are you applying for?
What is your wage requirement?
Are you available to work: (circle all that apply)

Days Evenings Weekends

Full Time Part Time Seasonal
Please list any days you are unable to work:
Are you legally authorized to work in the United States?

Yes No
Are you at least 18 years of age?

Yes No
Have you ever been employed with us before?

Yes No
If yes, give date:



If yes and under a different name, give name:
Have you ever applied for employment with LHP, Inc. or one of its divisions/subsidiaries?

Yes No
When would you be available to begin employment?

(mm/dd/yyyy)
Have you ever been convicted of a crime other than a minor traffic violation?

Yes No
If yes, please describe:



An affirmative answer will not necessarily disqualify you from employment

Education

Type of School Name Course of Study Last Year Attended Graduated
High School Yes
No
Vocational or Trade School Yes
No
College Yes
No
Graduate Yes
No
Describe any specialized training skills or qualifications you believe should be considered in evaluating your qualifications for employment:

Please list all computer software programs in which you are proficient:

If applying for an administrative/clerical position, what is your typging speed? WPM

Employment History



Start with your present or most recent job and continue with all past employment. (Email us more information if necessary)
Have you ever been discharged from any employment or asked to resign?

Yes No
If yes, please explain:

May we contact your current employer?

Yes No N/A
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Name of Company: Job title
From: (mm/dd/yyyy) To:
Address: City: State: Zip:
Job Duties: Reason for leaving:
Starting Salary: Final Salary:

Bonus/Commission:
Name and title of immediate supervisor: Telephone number:
Please explain any periods of unemployment and/or gaps in employment:

References

Name:

Occupation/ Job Title:
How do you know this person?

Address:

Telephone number:
Name:

Occupation/ Job Title:
How do you know this person?

Address:

Telephone number:
Name:

Occupation/ Job Title:
How do you know this person?

Address:

Telephone number:

Applicants's Certification and agreement



Please read the following statement carefully before submitting
I certify that the informatino contained in the application is true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application will be cause for denial of employment or termination of employment, regardless of when or how discovered. I authorize the investigation of all statements and information contained in this application. I release from liability anyone supplying such information.


I further certify that I am not a party to any agreement or understanding, written or oral, which prevents me from working for the company or preventing me from performing duties of the position I am submitting this application. If there is any legal impediment which prevents me from performing the job for which I am hired. I understand that this will be cause for denial of employment or termination of employment, regardless of when or how discovered. I further certify that if I am hired, I will not improperly use or disclose any confidential information or trade secrets, if any, of any former employer or person to whom I have an obligation of confidentiality unless consented to in writing by that former employer or person.


In consideration of my employment, I agree to abide by the Company's rules and regulations. I understand that my employment may be terminated with or without cause, with or without notice, at any time at the option of the company or myself.


I agree to the above.

 Date/Time: 2/4/2012 9:19:40 PM


www.litehouse.com