Luma Staffing & Filing Employment Application
8910 E 21 Street, Indianapolis, IN 46219 - Phone (317) 540-8486
Name
*
First Name
Last Name
Birthday
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Month
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Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Email
Confirmation Email
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Can we email you information about job opportunities?
Yes
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Position Applying for:
Desired Salary:
Date Available
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Year
Date
Days and Hours available for work
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What language(s) do you speak fluently?
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What language(s)do you understand and write well?
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Do you have authorization to work in the United States?
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Yes
No
Do you have a valid drivers license?
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Yes
No
Do you have reliable transportation?
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Yes
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Have you ever worked for Luma Staffing before?
Yes
No
Do you know anybody who works for Luma Staffing
Yes
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If yes, please include name and relationship
How did you hear about Luma Staffing?
Have you ever been convicted of a felony?
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If yes, explain:
Previous Emplyment
Please include the last 5 years of employment, starting with the most recent
Company 1
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Company Address 1
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Job Title
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Start Date
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Day
Year
Date
End Date
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Year
Date
Ending Salary
*
Responsibilities
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Reason for leaving
Company 2
Address Company 2
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Phone Number 2
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Job Title
Start Date
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Month
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Day
Year
Date
End Date
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Ending Salary
Responsibilities
Reason for leaving
Company Name 3
Address 3
Street Address
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Phone Number 3
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Job Title
Start Date
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Year
Date
End Date
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Month
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Year
Date
Ending Salary
Responsibilities
Reason for Leaving
Education
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Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Relationship
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Which industries interest you?
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What jobs or functions interest you?
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I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application may result in my termination.
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