Laparkan

Application for Employment

An Equal Opportunity Employer

A Drug-Free Workplace

Position(s) Applied for

Full Time

Part Time

Temp/Seasonal

Name

Address:

Apt#:

City:

Zip:

Home Phone:

Business Phone:

Have you filed an application here before?

Yes

Have you ever been employed here before?

Yes

Are you on layoff and subject to recall?

Yes

Can you travel if job requires it?

Yes

Date available for work

What is your desired salary range?

If you are under 18, and it is required, can you furnish a work permit?

Yes

If no, please explain:

Are you legally eligible for employment in this country?

Yes

Are you able to meet the attendance requirements of the position?

Yes

Will you work overtime?

Yes

How were you referred?

List names of relatives and friends who work here

Relationship

Have you ever plead "guilty" or "no contest" to, or been convicted of a crime? (Conviction information will not necessarily exclude you from a position unless it's job related.)

Yes

If Yes, please explain:

Educations

High School Name

Years Completed

Address

Diploma?

Yes

College Name

Years Completed

Address

Diploma?

Yes

Graduate Name

Years Completed

Address

Diploma?

Yes

Technical or Special Training

Describe:

Do you have experience in the following areas

Other computer software, specialized equipment, and/or business machines you have operated

Employment Experience

List each job held. Start with your present or most recent job

EMPLOYER 1

Name:

Address:

Tele:

Employed

From

Mo./Yr.

Supervisor's Name/Job Title

May we contact:

Yes

Your Job Title

Your salary

Start

End

Duties

Reasons for leaving

EMPLOYER 2

Name:

Address:

Tele:

Employed

From

Mo./Yr.

Supervisor's Name/Job Title

May we contact:

Yes

Your Job Title

Your salary

Start

End

Duties

Reasons for leaving

EMPLOYER 3

Name:

Address:

Tele:

Employed

From

Mo./Yr.

Supervisor's Name/Job Title

May we contact:

Yes

Your Job Title

Your salary

Start

End

Duties

Reasons for leaving

EMPLOYER 4

Name:

Address:

Tele:

Employed

From

Mo./Yr.

Supervisor's Name/Job Title

May we contact:

Yes

Your Job Title

Your salary

Start

End

Duties

Reasons for leaving

If unemployed at any time, please describe reasons for unemployment.

Have you ever been discharged or forced to resign for misconduct or unsatisfactory performance?

Yes

If yes, please give details

Membership in Organisation/Professional groups which, in your opinion, have a direct bearing on the position you are seeking.

Give any additional information which you feel may be helpful to us in considering your application

PLEASE READ AND SIGN STATEMENTS BELOW

I understand that, in accordance with Florida Statute 443.131(3)(a)(2)if hired, I will be placed on a 18 0-day probationary period. I further understand that if I am terminated for unsatisfactory work performance within the 180-day probationary period, the employer may seek to contest any unemployment benefit I might attempt to obtain as a result of my termination.

(Initials)

understand and agree that all policies, procedures, and the Employee Handbook may be modified, amended, or deleted by the Company with or without notice to me of such amendment, modification or deletion, that the policies and procedures are not intended to be a contract of employment nor do they give me any right of continued employment; and that my employment may be terminated at my option or at the option of this Company with or without notice by either party. I also understand that there are no other arrangements, agreements, or understanding regarding the terms of employment. There may be no amendments or exceptions to this statement unless they are in writing.

(Initials)

I certify that all information given on this employment application, any resume that I submit to the Company, and any related employment papers and answers given during oral interviews are true and correct. I understand that this Company may make a thorough investigation of my work and personal history. I authorize the giving and receiving of any such information requested by this Company during the course of such an investigation. I understand that if any information I have submitted is discovered to be false, I may be disqualified for employment and, if already employed, I may be subject to immediate dismissal. I hereby release from liability all persons who provide information to my employer during the course of any such investigation.

(Initials)

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporation or organizations for furnishing such information about me

(Initials)

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application

(Initials)

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard

(Initials)

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing statement.

Date:

Signature:

Laparkan

Fax:305.696.0958

Please attach a .pdf copy of your resume

File Name