Employment Application

AA/EEOC/LEP: No otherwise qualified person shall be excluded from employment, be denied the benefits of employment or otherwise be subject to discrimination in employment in any manner on the basis of sex, color, ancestry, disability or association with a person with a disability, marital status, race, creed (religion), age (over 40), arrest or conviction record, honesty testing, national origin, pregnancy or childbirth, sexual orientation, genetic testing, military service membership, political belief or use or non-use of lawful products. Limited English Proficiency: The right to qualified interpreter services at no cost to applicant, the right not to be required to rely on minor children, other relatives, or friends as interpreters and the right to file a grievance about the language access services provided to them.

**INCOMPLETE APPLICATIONS WILL NOT BE CONSIDEREDFOR EMPLOYMENT**

Please be sure to fill out the EEOC/AA as well.

Basic Information Part I

Position or Area of Interest: *

Please provide the position you wish to apply.

Date: *

How did you hear about us?: *

Please be as specific as possible.

First Name: *

Middle Name:

Last Name: *

Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Please provide the best number to reach you at.

E-mail Address: *

Employment History

**This section must be completed, regardless if a resume is attached**

PLEASE GIVE ACCURATE, COMPLETE FULL-TIME AND PART-TIME EMPLOYMENT RECORD. START WITH YOUR PRESENT OR MOST RECENT EMPLOYER.
List all employers within the last 5 years

Employer 1

I-Employer:

I-Address:

I-Phone:

I-Job Title:

I-Reason for Leaving:

I-Start Date:

I-End Date:

I-Start Hourly Rate: $

I-End Hourly Rate: $

I-Work Performed:

Employer 2

II-Employer:

II-Address:

II-Phone:

II-Job Title:

II-Reason for Leaving:

II-Start Date:

II-End Date:

II-Start Hourly Rate: $

II-End Hourly Rate: $

II-Work Performed:

Employer 3

III-Employer:

III-Address:

III-Phone:

III-Job Title:

III-Reason for Leaving:

III-Start Date:

III-End Date:

III-Start Hourly Rate: $

III-End Hourly Rate: $

III-Work Performed:

Employer 4

IV-Employer:

IV-Address:

IV-Phone:

IV-Job Title:

IV-Reason for Leaving:

IV-Start Date:

IV-End Date:

IV-Start Hourly Rate: $

IV-End Hourly Rate: $

IV-Work Performed:

Employer 5

V-Employer:

V-Address:

V-Phone:

V-Job Title:

V-Reason for Leaving:

V-Start Date:

V-End Date:

V-Start Hourly Rate: $

V-End Hourly Rate: $

V-Work Performed:

Employer 6

VI-Employer:

VI-Address:

VI-Phone:

VI-Job Title:

VI-Reason for Leaving:

VI-Start Date:

VI-End Date:

VI-Start Hourly Rate: $

VI-End Hourly Rate: $

VI-Work Performed:

Employer 7

VII-Employer:

VII-Address:

VII-Phone:

VII-Job Title:

VII-Reason for Leaving:

VII-Start Date:

VII-End Date:

VII-Start Hourly Rate: $

VII-End Hourly Rate: $

VII-Work Performed:

Employer 8

VIII-Employer:

VIII-Address:

VIII-Phone:

VIII-Job Title:

VIII-Reason for Leaving:

VIII-Start Date:

VII-End Date:

VIII-Start Hourly Rate: $

VIII-End Hourly Rate: $

VIII-Work Performed:

Comments:

COMMENTS: Include explanation of any gaps in employment (please do not include medical or personal information)

Education

College

Name and Address:

Course of Study:

Years Completed:

Did You Graduate?:

Yes

Degree or Diploma:

Bus/Trade/Tech

Name and Address:

Course of Study:

Years Completed:

Did You Graduate?:

Yes

Degree or Diploma:

High School

Name and Address:

Course of Study:

Years Completed:

Did You Graduate?:

Yes

Degree or Diploma:

Specialized Skills

Please provide a brief description of your skills?: *

Please provide us information regarding your specialized skills. (i.e. Computer programs you are proficient with, Typing {WPM}, Equipment you have used, CDL/PPL Licenses, Other Languages, etc...)

Any other training, certifications or licenses held?: *

State any additional information you feel may be helpful to us in considering your application::

Electronic Signature: *

BY TYPING YOUR NAME IN THIS BOX YOU AGREE TO THE FOLLOWING:
I CERTIFY THAT ANSWERS GIVEN HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
I AUTHORIZE LA CAUSA, INC TO INVESTIGATE ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION.
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 NOT CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.
I UNDERSTAND THAT EMPLOYMENT OR CONTINUED EMPLOYMENT IS DEPENDENT UPON RECEIPT OF SATISFACTORY EMPLOYMENT/CHARACTER REFERENCES, DRUG TEST, GANG ACTIVITY STATEMENT, DRIVER'S RECORD, RESULTS OF A CRIMINAL HISTORY BACKGROUND CHECK AND ANY OTHER REQUIRED DOCUMENTATION.
IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) AND/OR BACKGROUND DISCLOSURES MAY RESULT IN DISCHARGE. I ALSO UNDERSTAND THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE EMPLOYER.

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