Employment Application Electronic

Employment Application Electronic

PERSONAL INFORMATION

NAME (LAST NAME FIRST) SOCIAL SECURITY NO
PRESENT ADDRESS CITY STATE ZIP CODE
PHONE NO REFERRED BY

EMPLOYMENT DESIRED

Position Date You Can Start Salary Desired
Are you Emplyed YESNO If So, May We Inquire of your Present Employer? YESNO
Ever Applied To Laszeray Technology Before?YESNO When APPROXIMATE DISTANCE FROM PERMANENT RESIDENCE TO LASZERAY TECHNOLOGY?
DESIRED SHIFT FIRSTSECONDTHIRD WOULD YOU ROTATE TO A DIFFERENT SHIFT?YESNO

EDUCATION HISTORY

NAME & LOCATION OF SCHOOL YEARS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL

GENERAL INFORMATION

SUBJECTS OF SPECIAL STUDY/RESEARCH
WORK OR SPECIAL TRAINING/SKILLS
U.S. MILITARY OR NAVAL SERVICE RANK

FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE MONTH AND YEAR NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

I certify that the facts contained in this application and/or interview(s) are true and complete. Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.

I understand that, if employed, I will be an employee-at-will. As an employee-at-will, I understand that my employment is not guaranteed for any term, and my employment may be terminated by the employer or myself at any time and for any reason with or without prior notice. No representative of this company other than the owner(s) is authorized to make any assurance or promise of continued employment and any such assurance must be in writing signed by the owner(s). I further understand the employer reserves the right to modify compensation, as well as any other terms and conditions of employment, at any time

If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of this company. This application will remain on active file for 180 days. If I am hired within this period, this form will be transferred to my individual personnel file. If I am not hired or have not heard from this employer within 180 days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a job with this company.

I give this employer and /or its agents, including consumer reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment. This investigation may include, but is not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer, its representatives, all persons and organizations/companies for furnishing such information.

If required, I agree to submit to a drug testing prior to and during employment under the terms of the employer’s drug testing policy, which may include testing based on a reasonable suspicion of abuse or influence as well as post-accident and/or post-injury testing. In accordance with federal law, I understand that I must submit satisfactory proof of identity and eligibility to work in the United States within three (3) days of being hired or I will be subject to termination.

This employer is an Equal Opportunity Employer. This employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.

NOTICE: This is to inform you that as part of processing your employment application, we may obtain a consumer report and/or an investigative report which includes information as to your character, general reputation, personal characteristics and mode of living. If an investigative report is requested, you have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. By signing below, you acknowledge receipt of a copy of this notice and a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act.”



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