Application For Employment
 
Application Date:

It is the policy of Litehouse, Inc. to provide equal opportunity to all applicants and to administer all personnel tactics such as recruiting, hiring, promotions, and other terms, conditions and privileges of employment in a manner which does not discriminate on the basis of race, color, creed, ancestry, national origin, religion, sex, age, or marital status.

Click here to report a problem with this form.
General Information:
= Required Fields
       
First Name:
Middle:
Last Name:
Address:
Email:
Address (line 2):
City:
State:
(2 char state abbrev)
Zip Code:
Home Phone:

(use format: xxx-xxx-xxxx)
Alt Phone:
Other Information:
How did you learn about us?
   
Have you ever been employed by Litehouse in the past? Yes No
If Yes, when and what position?
   
Reason for leaving?

Please list any special skills:

(Machine Operations, Computer, Forklift License, etc.)
Position Applied for:
and Apply Category:  
     

Are 18 or older?
Yes No 
Available Full Time?
Yes No  
Desired Shifts
Willing to work overtime if asked?
Yes No 
Willing to work weekends if asked?
Yes No 
Have you been convicted of a felony?
Yes No 
Are you legally available for work in the US?
Yes No
 A conviction is not an automatic bar to employment
Education:
High School Name:
HS course of study:
High School location:
Number of years attended:
Did you graduate HS?
 Yes (or have a GED) No 
College Name:
College course of study:
College location:
Number of years attended:
Did you graduate College?
 Yes No     
       
Other Training:
  
Previous Employment:  
Most recent Employer:
Their address:
City:
State:
Zip:
Phone:
Start date (MM/DD/YYYY):
End date (MM/DD/YYYY):
Start pay:
End pay:
Job Title:
  
Job Duties:
  
Reason for leaving:
  
     
Previous Employer:
Their address:
City:
State:
Zip:
Phone:
Start date (MM/DD/YYYY):
End date (MM/DD/YYYY):
Start pay:
End pay:
Job Title:
  
Job Duties:
  
Reason for leaving:
  
       
Previous Employer:
Their address:
City:
State:
Zip:
Phone:
Start date (MM/DD/YYYY):
End date (MM/DD/YYYY):
Start pay:
End pay:
Job Title:
  
Job Duties:
  
Reason for leaving:
  
Please Read:  
 

I hereby authorize invesigation by Litehouse, Inc. of all statements contained in this application including access to records of any former employer, police department, educational institution to verify accuracy of information , and other services concerning me, and authorize such sources to release such information without liability for any damage whatsoever incurred in finding such information.
  I agree to work the hours and shifts deemed necessary by Litehouse, Inc.
  Litehouse may require you to work for one year before being eligible to transfer between departments.
  Note: Our building is a non-smoking, non-tobacco environment. We also require drug/alcohol testing.
  Any falsification, misrepresentation or omission of requested information may result in immediate dismissal or refusal of employment.
  Important: Make sure you have acknowledged the above statements as it represents your electronic signature of agreement.
Voluntary Information - Affirmative Action:
 

To be completed by applicant. Not for interview purposes. To be filed seperately from application. This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or is necessitated by another Federal Law or regulation.

As required, we comply with government regulations including Affirmative Action obligations where they apply.

In an effort to comply with requirements regarding government record keeping, reporting and other legal obligations, we ask that you complete this applicant data survey. Your cooperation is appreciated.

Please be advised that this survey is not a part of your official application for employment. It is considered confidential information that will not be used in any hiring decision.

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, veteran status or any other legally protected status.

To Vietnam Era Veterans, Disabled Veteran, and individuals with physical and mental disabilities:

Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans, veterans of the Vietnam era and qualified handicapped individuals. You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential. Refusal to provide this information will not adversely affect your consideration for employment.
Sex: Male Female 
Ethinicity:
Vietnam Veteran (1964-1975)? Yes No 
Disabled Veteran?
 Yes No 
Individual with a disability? Yes No 
Referral Source:
   
Referred by:
       
 
 

© 2004 Litehouse, Inc.
JADE v1.3 updated 9/7/2007