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Qualified applicants receive equal consideration. No
question is asked for the purpose of excluding any applicant due to
race, creed, color, national origin, religion, age, sex, handicap,
veteran status, marital status, sexual orientation, or any other
characteristic protected by law. We are an equal opportunity employer.
The field descriptions in BLUE text are required. |
| Contact Information |
| First
Name: |
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Last
Name: |
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| Address: |
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| City: |
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State: |
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| Zip: |
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Home Phone: |
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Cell Phone: |
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| E-mail: |
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| Desired
Position: |
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| Do You Want: |
Full-Time
Part-Time
Either |
| Salary Range Desired: |
Weekly |
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| Employment History |
| Please list chronologically, beginning
with most recent experience. |
| Employer: |
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Address/City: |
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| From
(MM/YYYY): |
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To
(MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of
Work: |
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| Reason for
Leaving: |
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| Employer: |
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Address/City: |
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| From
(MM/YYYY): |
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To
(MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of
Work: |
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| Reason for
Leaving: |
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| Employer: |
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Address/City: |
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| From
(MM/YYYY): |
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To
(MM/YYYY): |
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| Supervisor: |
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Phone: |
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| Salary: |
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| Type of
Work: |
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| Reason for
Leaving: |
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| Education |
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| Other Information |
Are you
legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of
work authorization.) |
Yes
No |
| Are you
at least 18 years of age?: |
Yes
No |
| Briefly describe skills you may have that
you acquired in other employment or armed forces: |
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| Have you
ever been convicted of a crime (felony)?: |
Yes
No |
If yes, give details:
(Convictions are not automatic bar to
employment) |
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| If you are experienced operator of any
office machines or equipment, please list: |
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| If you are experienced operator of any plant
machines or equipment, please list: |
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| Do you have any other skills you wish to
mention?: |
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| Are you
presently employed?: |
Yes
No |
| If so,
may we contact your present employer?: |
Yes
No |
| If
hired, when would you be available?: |
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| Employment References |
| List individuals familiar with your
job qualifications (No relatives or personal friends). |
| 1) Name of
Reference: |
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2) Name of
Reference: |
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| Occupation: |
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Occupation: |
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| Address: |
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Address: |
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| City/State/Zip: |
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City/State/Zip: |
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| Phone: |
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Phone: |
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| Relationship: |
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Relationship: |
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| How long
known: |
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How long
known: |
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| Please read carefully before submitting your
application |
All information contained in this application
is true and correct to the best of my knowledge and belief. I
understand that misrepresentations or omissions of any kind may
result in denial of employment or be cause for subsequent dismissal
if I am hired. I authorize the company to investigate my responses
on this application and contact any or all of my former employers or
any individuals familiar with me or my employment background for the
purpose of verifying any information, I have provided and/or for the
purpose of obtaining any information, whether favorable or
unfavorable, about me or my employment. I voluntarily and knowingly
fully release and hold harmless any person or organization that
provides information pertaining to me or my employment. I understand
that upon receiving a job offer, a physical examination and drug
screening may be required. (Note: If this is a job requirement, you
will be notified.)
Regardless of whether or not I become
employed by the company, I recognize that this application is not
and should not be considered a contract of employment. I understand
that employment at the company is on an at-will basis and that my
employment may be terminated with or without cause, and without
notice, at any time, at my option or the company's unless
specifically provided otherwise in a written employment contract. I
further understand that no company employee or representative has
the authority to enter into a contract regarding duration or terms
and conditions of employment other that an officer or official of
the company, and then only by means of a signed written document. We
have a policy of no smoking on the premises
I UNDERSTAND THAT NOTHING CONTAINED IN THIS APPLICATION, OR CONVEYED DURING ANY INTERVIEW WHICH MAY BE GRANTED, IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT. I UNDERSTAND THAT FILING OUT THIS FORM DOES NOT INDICATE THERE IS A POSITION OPEN AND DOES NOT OBLIGATE LEISURE HOME PRODUCTS TO HIRE ME..
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Check this box to certify that you
have read and accept the above statement. |
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Phone:
228-822-2238 
