Lafayette Interior Fashions Application for Employment

Application for Employment

Any applicant who is unwilling to agree to any of these conditions contained in this application should not apply for employment with Lafayette Venetian Blind, Inc.
Personal
Name*

First NameMiddle InitialLast Name
Social Security No.*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:

Area CodePhone Number
Alternate No.

Area CodePhone Number
Email Address
example@example.com
Please list any other names used:

Education (Education will be considered only to the extent relevant for the position for which you are applying)
Grade School Name & Location:
Number of Years
High School Name & Location:
Number of Years
College Name & Location:
Number of Years
Major
Other:
Number of Years
Major

Personal References (Please list three individuals who are not related to you, do not live with you, and have known you for at least three years)
1. Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship:
How long have you known this person?
2. Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship:
How long have you known this person?
3. Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Relationship:
How long have you known this person?

Employment History - (Next 3 pages) (Most recent experience FIRST - Include ALL employers for past 5 years)
1. Employer:
Supervisor:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Starting Salary/Wages:
Final Salary/Wages:
Month & Year of Employment:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you receive any disciplinary actions in your last 12 months of employment?

YesNo
If yes, please explain
Duties:
Reason for Leaving:

2. Employer:
Supervisor:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Starting Salary/Wages:
Final Salary/Wages:
Month & Year of Employment:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you receive any disciplinary actions in your last 12 months of employment?

YesNo
If yes, please explain
Duties:
Reason for Leaving:

3. Employer:
Supervisor:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Starting Salary/Wages:
Final Salary/Wages:
Month & Year of Employment:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Did you receive any disciplinary actions in your last 12 months of employment?

YesNo
If yes, please explain
Duties:
Reason for Leaving:

For employment with Lafayette Venetian Blind, I understand the following:

This facility is an Equal Opportunity Employer.

Applications remain on active file for 6 months. After 6 months if there is no response, a new application must be submitted if employment with Lafayette Venetian Blind, Inc. is desired.

Reasonable accommodation will be provided during the employment selection process. If needed, individuals should notify the Human Resource Department at (765) 464-2641.

I authorize Lafayette Venetian Blind to perform an MVR background check, pre-employment credit history check and a background check (including a criminal background check), with the understanding that the findings will not necessarily disqualify me from the employment selection process.

I agree/authorize Lafayette Venetian Blind, Inc. to do a pre-employment drug screen analysis with any laboratory designated by Lafayette Venetian Blind, Inc. and to request the release of any information requested on samples submitted.

I agree that I must have a negative drug screen to be considered for employment, a positive result will cause my application for employment to be rejected and any conditional offers of employment will be withdrawn.

I release Lafayette Venetian Blind, Inc. and all affiliated, from any and all liability, claims, demands, damages, causes of action of every kind, and any employment decision made by Lafayette Venetian Blind, Inc. resulting from submission and results of drug and alcohol screenings or searches.

If employed, I agree to comply with the safety/health rules and regulations, and rules of conduct of Lafayette Venetian Blind, Inc.

Employment is not guaranteed for any term, and employment may be terminated by Lafayette Venetian Blind, Inc. or employee at any time AND for any reason. No management official is authorized to make any oral assurance or promise of continued employment.

Lafayette Venetian Blind participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

I agree to all conditions listed in this application. I authorize that all information provided in this application (and any attached) is true, complete, and subject to verification; any misrepresentations, falsifications, or omissions will be cause for rejection of application or termination of employment if discovered at a later date.
Signature of Applicant*

Clear
Date*

MonthDayYear
Date

For Human Resources use ONLY
For Human Resources use ONLY
Hire Date

MonthDayYear
Date
Position
Supervisor
Department
Department #
Rule
Pay
Shift
Completed By:
Should be Empty: