THE SOLUTION FOR FAMILIES

SERVICES FOR ADULTS AND CHILDREN

Hire Packet Checklist

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION
*
*
Address *
Address
Mailing Address (if different)
Mailing Address (if different)
Phone *
Phone
Message Phone Number:
Message Phone Number:
EMPLOYMENT DESIRED
Date you can start:
Date you can start:
Have you ever been employed by LSF before?
Are you employed now?
If so, may we inquire of your present employer?
If you are hired, can you provide proof that you are authorized to work in the United States?
Have you ever been convicted of a crime other than a minor traffic offense?
A conviction in itself does not bar employment. Factores such as the nature and gravity of the crime, the length of time that has passed since the conviction and/or completion of any sentence, and the nature of the job for which you have applied will be considered.
EDUCATION
Did you graduate?
Did you Graduate?
Did you Graduate?
Did you Graduate?
EMPLOYMENT
List below your previous employers, starting with the most recent one first. Include and explain any periods of unemployment that lasted more than one month.
Address:
Address:
Phone:
Phone:
Employed From:
Employed From:
Employed To:
Employed To:
Address:
Address:
Phone:
Phone:
Employed From:
Employed From:
Employed To:
Employed To:
Address:
Address:
Phone:
Phone:
Employed From:
Employed From:
Employed To:
Employed To:
Address:
Address:
Phone:
Phone:
Employed From:
Employed From:
Employed To:
Employed To:
Are you able to perform essential functions of this job as described in the advertisement, announcement, job posting or interview process with reasonable or no accommodation?
Please use the space below to list any additional employers, periods of time not worked, or any other information that you believe we should know in considering your application for employment.
Please read carefully then initial each of the following statements:
If I am employed by LSF, I will comply with all work-related requirements set forth by LSF.
Initial here:
Initial here:
Initials here:
Initials here:
Initials here:
Initials here:
Type First Name and Last Name.
Date
Date
We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on the basis of race, color, national origin, religion, age, gender, or any status protected under applicable local, state or federal nondiscrimination laws. It is our intention that all participants be given equal opportunity and that selection decisions are based on job-related factors. No applicant will be rejected as a result of a disability that, with reasonable accommodation, does not prevent performance of the essential job duties.
Any person needing reasonable accommodations in the application process should contact the Human Resources Department