Employment Application
Lussier Community Education Center is an Equal Opportunity Employer, AA/EOE
Full Name
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First Name
Middle Name
Last Name
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
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example@example.com
Phone Number
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Date of Application
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-
Month
-
Day
Year
Date
Position Applied
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Type of Employment you are seeking (check all that apply)
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Full Time
Part Time
Seasonal
Temporary
AmeriCorps
Internship
Other
Have you ever applied for employment with LCEC? If yes, provide month & year.
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Have you been previously employed with LCEC? If yes, provide position title.
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Available Start Date
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-
Month
-
Day
Year
Date
Education & Training
Name & Location of School
Dates Atttended
Degree/Diploma
Graduate or Professional
College/University
Business, Trade, Vocational or Technical School
High School
Other Training, Education, Skills (not covered above)
List any volunteer, professional, trade, business, or civic activities and offices held. You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.
Employment History
Please start with your current or most recent employer.
1 - Employer
1 - Employer Address
1 - Job Title
1 - Dates of Employment (Month/Year - Month/Year)
1 - Hours Per Week
1 - Job Duties/Responsibilities
1 - Reasons for Leaving or Considering Leaving
1 - Name of Supervisor
1 - Phone Number or Email of Supervisor
1 - May we obtain references from this employer?
Yes
No
1 - When can we contact this employer (i.e. whenever, in 1 week, on x-date, etc.)
1 - If no, please explain
2 - Employer
2 - Employer Address
2 - Job Title
2 - Dates of Employment (Month/Year - Month/Year)
2 - Hours Per Week
2 - Job Duties/Responsibilities
2 - Reasons for Leaving or Considering Leaving
2 - Name of Supervisor
2 - Phone Number or Email of Supervisor
2 - May we obtain references from this employer?
Yes
No
2 - When can we contact this employer (i.e. whenever, in 1 week, on x-date, etc.)
2 - If no, please explain
3 - Employer
3 - Employer Address
3 - Job Title
3 - Dates of Employment (Month/Year - Month/Year)
3 - Hours Per Week
3 - Job Duties/Responsibilities
3 - Reasons for Leaving or Considering Leaving
3 - Name of Supervisor
3 - Phone Number or Email of Supervisor
3 - May we obtain references from this employer?
Yes
No
3 - When can we contact this employer (i.e. whenever, in 1 week, on x-date, etc.)
3 - If no, please explain
References
Provide the names, emails, and phone numbers of three references who are not related to you and are not previous employers. Options could include previous coworkers, mentors, colleagues, volunteer supervisors, friends, or teachers/professors. If you have told us that you would like us not to contact your previous employers, the following 3 references are required.
Reference 1
Reference 2
Reference 3
LinkedIn (optional)
Upload Your Resume (optional)
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Cover Letter or Writing Sample - Please express exactly why you are interested in this position and working at the LCEC. Describe to what extent your training and experience have given you the technical knowledge, skill, and interest to perform the type of work you are applying for.
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If you are considered for employment with Lussier Community Education Center, Inc., you will be asked to fill out a Background Information Form. Wisconsin’s Fair Employment Law, s. 111.31 –111.395, Wisconsin Statutes, prohibits discrimination because of criminal record or pending charge, unless the record or charge substantially relates to the circumstance of the particular job or licensed activity. By selecting "I understand" you are verifying that you are aware of this.
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I understand
I certify that all the information given on this application is true and complete to the best of my knowledge and agree that any false or missing information may disqualify me for this position. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
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Affirmative Action
Information requested for affirmative action use only and shall remain confidential. Completing this section of the application is completely optional. Lussier Community Education Center is an equal opportunity employer, which does not discriminate against individuals based on race, national origin, gender, physical disability, religion, sexual orientation, age, or any characteristics protected by law.
Name
First Name
Last Name
Position Applied
How did you hear about us?
Do you consider yourself handicapped or disabled?
Yes
No
If yes, what is your disability?
Gender
Agender
Cisgender - Female
Cisgender - Male
Genderqueer
Gender-Fluid
Gender Non-Conforming
Non-Binary
Transgender - Female
Transgender - Male
Other
Are you hispanic/latino?
Yes
No
Ethnic Group
American Indian or Native Alaskan
Asian
Black or African American
Native Hawaiian or Pacific Islander
Middle Eastern or North African
white
Mixed
Other
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