Little Mountain Printing Inc. - Employment Application Form

Employment Application Form
Answer all questions completely. Please print when not typing. Incomplete applications will NOT be considered. Prospective employees will receive consideration without discrimination due to race, creed, color, sex, age, nationality, handicap / disability, veteran, or any status protected by law.
Date*

MonthDayYear
Date of application
Name*

First NameMiddle NameLast Name
Street Address*
City, State, Zip*
Email*
example@example.com
Home Phone
Cell Phone
How long have you lived at this address?*
How long at a previous address?
Social Security # (Optional)
When will you be available to begin work?*
Position Applying For:*
Desired Starting Wage:*
REFERRAL SOURCE Check One*

AdvertisementEmployeeRelativeOther
Are you over the age of 18?*

YesNo
Are you legally eligible for employment in the United States?*

YesNo
(Proof of U.S. Citizenship, of Immigration status, or of your eligibility to work will be required prior to starting work

Education History*

	Name and Location of School	Course of Study	No. of Years Completed	Did You Graduate?	Degree or Diploma
College
Business/Trade Technical
High School

PESONAL REFERENCES:

Give names and telephone numbers of three references not related to you.
Personal Reference 1
Personal Reference 2
Personal Reference 3
EMPLOYMENT HISTORY
1.
Company Name
Address
Telephone
May we contact?

YesNo
Employed - (Month & Year)
From

MonthDayYear
Date
To

MonthDayYear
Date
Weekly or Hourly Pay
Start
Last
Name of Supervisor
State Job Title and Describe Your Work

0/100
Reason for Leaving:

0/100
2.
Company Name
Address
Telephone
May we contact?

YesNo
Employed - (Month & Year)
From

MonthDayYear
Date
To

MonthDayYear
Date
Weekly or Hourly Pay
Start
Last
Name of Supervisor
State Job Title and Describe Your Work
Reason for Leaving:

0/100
3.
Company Name
Address
Telephone
May we contact?

YesNo
Employed - (Month & Year)
From

MonthDayYear
Date
To

MonthDayYear
Date
Weekly or Hourly Pay
Start
Last
Name of Supervisor
State Job Title and Describe Your Work

0/110
Reason for Leaving:

0/100
4.
Company Name
Address
Telephone
May we contact?

YesNo
Employed - (Month & Year)
From

MonthDayYear
Date
To

MonthDayYear
Date
Weekly or Hourly Pay
Start
Last
Name of Supervisor
State Job Title and Describe Your Work
Reason for Leaving:

0/100
CRIMINAL HISTORY
Have you ever been convicted of a felony? (This will not necessarily affect your application)*

YesNo
If yes, please describe the circumstances:

0/250
QUALIFICATIONS & ADDITIONAL INFORMATION
Explain how you feel you would be an asset to this company:*

0/250
SPECIAL SKILLS
Summarize special job-related experience you have acquired over your career i.e. languages, machine operation, etc*

0/350
NAMES OF RELATIVES AND FRIENDS WORKING FOR US
*IF APPLYING FOR FISHWRAPPER DELIVERY POSITIONS
Can you lift 40lbs repeatedly?

YesNo
What type of delivery vehicle do you have? (A van, truck, or SUV is recommended)
Do you have a current valid driver's license?

YesNo
State
License #
Expiration Date

MonthDayYear
Date
Has your driver's license ever been revoked?

YesNo
If yes, explain:
Have you ever been cited for DUI?

YesNo
Please list all moving traffic violations in the last five (5) years.
EMERGENCY INFORMATION
In case of emergency, contact
Relationship
Address
Home Phone
Work Phone
APPLICANT'S STATEMENT
I understand that this is not a contract for employment.

I further understand that, if hired, my employment is "at will" and can be terminated at any time, with or without notice, and for any reason. I also understand that while personnel policies, programs, and procedures may become necessary to change from time to time, any change in the "at will" nature of my employment must be made in writing and signed by a designated authorized representative of Little Mountain Printing, Inc.

I hereby authorize investigation of all statements contained in this application as may be pertinent to an employment decision.

I certify that the information I have supplied in this application is true and complete to the best of my knowledge and I understand that any deliberate falsifications, misrepresentations, or omissions of fact may be grounds for rejection of my application or dismissal from subsequent future employment.
Signature of Applicant*

Clear
Date Signed*

MonthDayYear
Date
Attach Resume (Optional)

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Employment Application Form

PESONAL REFERENCES:

EMPLOYMENT HISTORY

CRIMINAL HISTORY

QUALIFICATIONS & ADDITIONAL INFORMATION

SPECIAL SKILLS

*IF APPLYING FOR FISHWRAPPER DELIVERY POSITIONS

EMERGENCY INFORMATION

APPLICANT'S STATEMENT