Lussier Community Education Center - Employment Application

Full Name *

First Name Middle Name Last Name

Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email Address *

example@example.com

Phone Number *

Date of Application *

Date

Position Applied *

Type of Employment you are seeking (check all that apply) *

Full Time Part Time Seasonal Temporary AmeriCorps Internship Other

Have you ever applied for employment with LCEC? If yes, provide month & year. *

Have you been previously employed with LCEC? If yes, provide position title. *

Available Start Date *

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.

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

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. *

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. *

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. *

Clear

Employment Application

Employment History

References

Affirmative Action