EmailMe Form - Lemos Job Application

Personal Information

Name *

First Last

Today's Date *

MM / DD / YYYY

Address: *

City: *

State *

Phone *

### - ### - ####

For which location(s) would you like to be considered? *

Hours/Days that you are available to work: *

Position(s) applied for: *

Rate of pay expected $ *

Input hourly wage, if not salaried.

Were you previously employed by us? *

Yes

No

If yes, when?

If your application is considered favorable, on what date will you be available for work? *

MM / DD / YYYY

Summarize skills, experience, special training which will be of special benefit in the job for which you are applying *

If employed, can you provide proof of U.S. citizenship of authorization to work in the U.S.? *

Yes

No

Are you at least 18 years of age? *

Yes

No

State age if under 18

Valid Drivers License *

Have you ever been convicted of any crime other than minor traffic violations? *

Yes

No

If yes, set forth the nature and dates of the conviction

EDUCATION:

Select last year completed *

Other training or education

EMPLOYMENT HISTORY:

List below all present and past employment, beginning with your most recent. Resumes may NOT be substituted for this information.

#1

Name of Company

Address

City

State

Position Held

Name of Supervisor

Phone

### - ### - ####

Type of Business

From Month/Year to Month/Year

Starting/Ending Salary

Reason for Leaving

Describe the Work You Did

#2

Name of Company

Address

City

State

Position Held

Name of Supervisor

Phone

### - ### - ####

Type of Business

From Month/Year to Month/Year

Starting/Ending Salary

Reason for Leaving

Describe the Work You Did

#3

Name of Company

Address

City

State

Position Held

Name of Supervisor

Phone

### - ### - ####

Type of Business

From Month/Year to Month/Year

Starting/Ending Salary

Reason for Leaving

Describe the Work You Did

May we contact your current employer?

Yes

No

"I certify that the information contained in this application is complete and correct to the best of my knowledge and understand that falsification or misinterpretation of this information is grounds for immediate dismissal in accordance with Lemos Feed & Pet Supply policy. I authorize the references listed above to give you any and all information concerning my previous employment as well as any pertinent information they may have, personal or otherwise, and release all parties from any and all liability for damage that may result from furnishing information to you. I understand that a more detailed investigation concerning my background may also be conducted and I hereby authorize such an investigation. I understand that nothing contained in this employment application is intended to lead or create an employment contract investigation. I understand that nothing contained in this employment application is intended to lead or create an employment contract between Lemos Feed & Pet Supply and myself with would restrict the right of the company to terminate my employment at will. I understand that Lemos Feed & Pet Supply maintains a zero tolerance drug and alcohol abuse policy and I agree to abide by these standards, or face disciplinary action up to and including termination of my employment, I agree to conform to the rules and regulations of Lemos Feed & Pet Supply and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or myself."

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Date *

MM / DD / YYYY

Comments