Application


Personal Information

Yes
No

Employement Desired

No
Yes
Yes
No
Yes
No

Education (Name and Location of School), Major, and Year Graduated

General

No
Yes

Personal Employers (List below your last three employers, starting with last one first)

References: Give the names of three persons not related to you, whom you have known for at least one year

In Case of Emergency Contact

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I hereby authorize LSCP to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. This may involve verifying the accuracy of information contained in this application from all previous employers, educational institutions, and references, as well as obtaining additional pertinent information they may have. I understand that LSCP may utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.

In consideration for my employment, I agree to conform to the company's rules and regulations.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I also understand and agree that the "at will" nature of the employment means the terms and conditions of my employment may be changed, with or without cause, and with or without prior notice, at any time by the company.

Required field

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