Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin or handicap.

Position Desired *

Prefix

First Name

Last Name

Suffix

Email *

Phone Number *

Street Address

Address Line 2

City

State

Zip Code

Length of Residency

Desired Salary

Available for Work Beginning

Can you perform the essential function of the position for which you are applying?
(If you have any question as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer this question.)

 YES NO

Are you legally eligible to be employed in the United States? *

(Proof of identity and eligibility will be required upon employment)

 YES NO

Are you over the age of 18 years?

(If no, you may be required to provide authorization to work.)

 YES NO

Do you have a reliable means of transportation?

 YES NO

Preferred work arrangement is:

 Full - Time Part - Time Per Diem Summer Only

Are you available to work (check all that apply)

 Day Evening Night Weekend


Days and Hours Available

(If employed, I will notify my supervisor in writing should my availability change) Example: 6AM-5PM

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Have you ever worked under another name?

 YES NO

(Identify Name and Reason for Change)

Are you presently Employed?

 YES NO

May we contact your employer?

 YES NO

Why are you considering leaving?

During the last 10 years, have you ever been convicted of a crime other than a minor traffic offense?

(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)

 YES NO

Identify the Conviction, the location where the felony or misdemeanor occurred, and the disposition of the case.

Have you ever worked for Laboratory Testing Inc. before?

 YES NO


Please fill out the forms below:

Department

Position

From

To

Why are you considering leaving?

Do you have any relatives or friends who work for Laboratory Testing Inc.?

 YES NO

Please List your relatives or friends who work for Laboratory Testing Inc.

Name

Relationship

Do you belong to any professional, trade, business, or civic organizations that deal with the position for which you are applying?

(Omit any organizations which reflect your race, color, religion, age, sex, sexual orientation, marital status or disabilities)

 YES NO

List them below:

Do You Have Any Professional Licenses or Certifications?

 YES NO

Number

Issued by

Expiration


Employment Record

List all employment beginning with the most recent.
If not previously employed, please list personal references.


Employer Name

Address

Position

From / To

Supervisor

Salary

Reason for Leaving


Employer Name

Address

Position

From / To

Supervisor

Salary

Reason for Leaving


Employer Name

Address

Position

From / To

Supervisor

Salary

Reason for Leaving


Education

Type of School

School Name

Address

From / To

Graduated?

Degree / Major

Do You Have a High School Equivalency Diploma?

 YES NO

Skills You Possess

 Typing Bookkeeping Computer Data Entry Calculator Dictaphone Other

What Prompted You to Apply for a Position at Laboratory Testing Inc.?

 In response to an advertisement An employee referral My own initiative Other


Personal References

Name

Occupation

Address

Phone Number

Name

Occupation

Address

Phone Number

Name

Occupation

Address

Phone Number


APPLICANT’S CERTIFICATION AND AGREEMENT

I have carefully read the application statement and have provided accurate information to the best of my knowledge. The facts set forth in this application are true and complete. Permission is given to Laboratory Testing Inc. to verify all information I have provided on this application. I authorize all persons or entities I have referred to in this application to provide any relevant information to Laboratory Testing Inc. or its agents for use in investigation and release them form any liability doing so.

I understand and agree that any omission or misrepresentation of facts in my application will be justification for refusal or termination of employment. I understand that this employment application and any other Company documents or statements are not contracts of employment. Employment is contingent upon satisfactory completion of employment and reference checks. A minimum of two positive reference checks are required for employment.

By Clicking "Submit" Below, you agree to these terms.

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