Job Application - Inspired LED

Application for Employment

Name (first, middle initial, last):*

Street Address:*

City:*

State:*

Zip Code:*

Phone Number:*

E-mail Address:*

If hired, can you provide evidence of legal eligibility to work in the U.S.?*

Yes
No

Have you ever been convicted of a felony or misdemeanor?*

Yes
No

Are you 18 years of age or older?*

Yes
No

Position Desired:*

Wage / Salary Desired:

Work Availability *

Full Time
Part Time

Available Start Date:*

Education

Name of High School:

Completion:

City & State:

Name of College or Technical School:

Graduate?

City & State:

Degree?

Major?

List any job-related skills or accomplishments, including military service:

Work Availability

Total hours per week you are available to work:

Your Availability For Work
Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

Do you have any special requests or needs for a work schedule?

References

Name (First & Last):	Occupation:
How do you know them?	How long have you known them?
Phone Number
Name (First & Last):	Occupation:
How do you know them?	How long have you known them?
Phone Number:
Name (First & Last):	Occupation:
How do you know them?	How long have you known them?
Phone Number:

Work History

May we contact current employers before you are offered a position?

Yes
No

Current (or most recent) Employer: Address: City & State: Zip Code: Supervisor: Telephone:	Job Title: Job Duties:
	Start Date:	End Date:
	Starting Pay:	Ending Pay:
	Reason for Leaving:
Previous Employer: Address: City & State: Zip Code: Supervisor: Telephone:	Job Title: Job Duties:
	Start Date:	End Date:
	Starting Pay:	Ending Pay:
	Reason for Leaving:
Previous Employer: Address: City & State: Zip Code: Supervisor: Telephone:	Job Title: Job Duties:
	Start Date:	End Date:
	Starting Pay:	Ending Pay:
	Reason for Leaving:

Acknowledgement and Authorization
Upon submission of this application, I certify that all answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.