Employment Application

Personal Information

Name

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home / Cell Phone*

Business Phone

May we contact you at work?*

Yes
No

Position applying for*

Date available*

Education

Type of School*

Please check all that apply.

High School
College
Graduate School
Other

High School

Name of school

Address of school

Street Address Address Line 2 City State ZIP Code

Degree / area of study

Number of years attended

Did you graduate?

Yes
No

College

Name of school

Address of school

Street Address Address Line 2 City State ZIP Code

Degree / area of study

Number of years attended

Did you graduate?

Yes
No

Graduate School

Name of school

Address of school

Street Address Address Line 2 City State ZIP Code

Degree / area of study

Number of years attended

Did you graduate?

Yes
No

Other School

Name of school

Address of school

Street Address Address Line 2 City State ZIP Code

Degree / area of study

Number of years attended

Did you graduate?

Yes
No

Military Service

Have you served in the U.S. Military?*

Yes
No

Branch of service

Technical specialization

Rank attained

Employment History

Start Date

End Date

Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your job title

Supervisor

Major duties

Starting wage

Ending wage

Reason for leaving

May we contact this employer?

Yes
No

Add another job?*

Yes
No

Start Date

End Date

Employer

Address

Street Address Address Line 2 City State ZIP Code

Your job title

Supervisor

Major duties

Starting wage

Ending wage

Reason for leaving

May we contact this employer?

Yes
No

Add another job?*

Yes
No

Start Date

End Date

Employer

Address

Street Address Address Line 2 City State ZIP Code

Your job title

Supervisor

Major duties

Starting wage

Ending wage

Reason for leaving

May we contact this employer?

Yes
No

References

Business references only. Do not list relatives.

Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Title

Years known

Add another reference?*

Yes
No

Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Title

Years known

Add another reference?*

Yes
No

Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Title

Years known

File Upload

Please upload your resume or other supporting documents. Optional.

Choose a file to upload

Max. file size: 128 MB.

Please Read Carefully

I understand that, with my authorization, an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record and/or criminal history, subject to applicable federal, state and/or local laws.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of LeMatic.

I understand and agree that, if employed, the employment will be "at will." That is, either I or LeMatic may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by LeMatic does not imply employment and that this application and/or any other LeMatic docuemtns are not contracts of employment.

Signature