LUMEN STAFFING - APPLICATION

1. APPLICATION FORM
It is our policy to follow all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Carefully read and answer all questions. You will not be considered employment if you do not completely answer all the questions on this application. You may attach a résumé, but all questions must be answered.
Position applying for
Personal Data
Name (first, middle, last)*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Cell phone number*
Format: (000) 000-0000.
Email Address*
example@gmail.com
Emergency Contact (Name/Phone#)
Date available*

MonthDayYear
Date
Salary Desired
Ex: $15/h
Do you have a High School Diploma or GED?
Position Information
Full Time/Part Time
Day / Night
Swing / Over Night / Weekend
Status: Regular / Temporary
YesNo
YesNo
If Yes, please explain
YesNo
YesNo
You can upload your resume here (optional but recommended). The file size should be smaller than 5MB.

Cancelof

QUALIFICATIONS, please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

REFERENCES, please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.
References

please list three professional references not related to you, with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.
Name
Address/City/State
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Work history
YesNo
Job Title
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Company Name
Supervisor's Name
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
Reason for Leaving
Starting Salary
Ending Salary
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions, or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.
I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
Applicant Signature*
Date*

MonthDayYear
Date
Please verify that you are human*

I understand it.
Should be Empty:

1. APPLICATION FORM

Personal Data

Position Information

References

Work history