Employment Application

 

 

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APPLY FOR EMPLOYMENT

Please complete each section of the application. At the end of each page, you will advance to the next section of the application. On the final page, you will be allowed to upload a resume, cover letter, or any other document you feel benefits your application.

_______________________________________________________________________________________________

Applicant Name:
Type of Work Desired:

Full Time Part Time Temporary Internship

Street Address:
Position Applied For:
City:
Date Available:
State:
Do you have a valid drivers license?
 Yes
No
Zip Code:
Are you a Veteran:
 Yes
No
Email Address:
Veterans Preference:

WWII
Korean Incident
Vietnam Era
Desert Storm/Shield
Home Phone:
Are you legally eligible for employment in the United States:
 Yes
No
Cell Phone:
Are you age 16 or over:
 Yes
No
Do any of your relatives work for LHA?
Yes
No
Have you ever worked for LHA?
Yes
No

EMPLOYMENT RECORDS

List below the positions you have held starting with your present employment.  If more than one position or classification has been held with a given organization, list each position or classification as a separate period of employment.  Under “Specific Duties” describe clearly the tasks you performed and the nature of your supervisory, technical or other responsibilities.    Please be complete.  Your employment history may be verified by contacting previous employers unless you request otherwise.  Volunteer or unpaid experiences will be evaluated in the same manner as paid employment and should be entered in the same manner. 

EMPLOYER ONE

Employer:
Position Title:
Employer Address:
Number Supervised:
Employer City:
Specific Duties:
Employer State:
Reason for Leaving:
Employer Zip:
    
ImmediateSupervisor/Title:
    
Employer Phone:
    
Dates of Employment:
    
HourlyRate/Salary:
    
Length of Employment:
    
Employment Type:
 Part-Time
Full Time		    
Hours Worked Per Week:
    

EMPLOYER TWO

Employer:
Position Title:
Employer Address:
Number Supervised:
Employer City:
Specific Duties:
Employer State:
Reason for Leaving:
Employer Zip:
    
ImmediateSupervisor/Title:
    
Employer Phone:
    
Dates of Employment:
    
HourlyRate/Salary:
    
Length of Employment:
    
Employment Type:
 Part-Time
Full Time		    
Hours Worked Per Week:
    

EMPLOYER THREE

Employer:
Position Title:
Employer Address:
Number Supervised:
Employer City:
Specific Duties:
Employer State:
Reason for Leaving:
Employer Zip:
    
ImmediateSupervisor/Title:
    
Employer Phone:
    
Dates of Employment:
    
HourlyRate/Salary:
    
Length of Employment:
    
Employment Type:
 Part-Time
Full Time		    
Hours Worked Per Week:
    

EDUCATION AND SKILLS

Give your complete educational history. Transcripts of post high school coursework may be required.

 

Are you Bilingual:
 Yes
No
What Foreign Languages :
Special Skills/Coursework:
High School Name:
High School Last Year:
1
2
3
4
High School City:
High School Grad:
High School State:
High School Major:
College Name:
College Year:
1
2
3
4
College City:
College Grad:
Yes
No
College State:
College Degree:
College Major:
College Last Year Attended:
Other School Name:
Other School Major:
Other School City:
Other School Graduate:
Other School State:
Other School Last Year Attended:

LICENSES AND CERTIFICATIONS

If a license, certificate or other authorization to practice a trade or profession is required for the position for which you are applying complete the following questions.

 

Name of Trade/Profession:
Granted By:
Specialty:
License Number:

After reviewing your application please click the Submit Button Below. ONCE THE APPLICATION IS SUBMITTED PLEASE CLICK BELOW TO ENTER YOUR REFERENCES.

Online Reference Entry Form