LCECD Application

Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Name*

First NameMiddle NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InReferralNewspaper AdFacebookTwitterLinkedInOther (please specify)
Are you a citizen of the U.S. and have a legal right to work here?*

YesNo
Are you 18 years of age or older?*

YesNo
Have you ever "plead guilty", "no contest" or been convicted of a crime?*

YesNo
If you answered Yes to the question above please explain
By submitting this application you are consenting to a full criminal background check
Type of employment desired:*

Part TimeFull Time
Available Date To Start:*

MonthDayYear
Date
Desired salary: *
Resume and Files

Attach a copy of your resume and any certifications
Cancelof
Tell us about yourself
You may exclude membership which would reveal sex, race, color, genetic information, religion, national origin, age, disability or other protected status.
Training and Certifications
Education:*
Education:
Education:
Employment Experience*
Employment Experience
Employment Experience
References

Please list three (3) references that are familiar with your work life. Exclude relatives and former employers.
Reference*
Reference*
Reference*
Signature - Please enter your full name
I certify that all answers and statements in this application are true and complete to the best of my knowledge. I understand that should this application contain any false or misleading information, my application may be rejected or my employment with this agency terminated.
Today's Date:
Should be Empty:

Employment Application