Employment Application - L & R Mechanical Services LLC

Date / Time

Date

Time

Position Applying For

Use drop down menu to select the appropriate job applying for.

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Date Available

Date you can Start

and Discharge previous

Last Four of Social Security No.

XXXX

Are you a citizen of the United States?

Yes
No

If no, are you authorized to work in the U.S. ?

Yes
No
NA

Have you ever worked for this company?

Yes
No

If Yes, when?

Dates

Have you ever been convicted of a felony?

Yes
No

If yes, explain:

Did you Graduate High School or Get Your GED?

Yes
No

Education High School or GED

High School / From:-To:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you Graduate From College or Other Higher Education Program

Yes
No

Higher Education

College / From: – To:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Degree

(NA if this does not apply)

Did you Graduate from a Technical or Certificate Program?

Yes
No

Other Education

School / From: – To: (NA if this does not apply)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Degree or Certificate

(NA if this does not apply)

Professional References 1

First

Last

Name

Relationship

Company

Phone

Professional References 2

First

Last

Name

Relationship

Company

Phone

Professional References 3

First

Last

Name

Relationship

Company

Phone

Previous Employment 1

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Responsibilities

Supervisor Name

First

Last

Phone

Reason for leaving

May we contact your previous supervisor for a reference

Yes
No

Do you need a second employment spot?

Yes
No

Previous Employment 2

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Responsibilities

Supervisor Name

First

Last

Phone

Reason for leaving

May we contact your previous supervisor for a reference

Yes
No

Do you need a third employment spot?

Yes
No

Previous Employment 3

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Title

Responsibilities

Supervisor Name

First

Last

Phone

May we contact your previous supervisor for a reference

Yes
No

Did you Serve in the Military

Yes
No

Reason for leaving

Military Service

Branch (NA if this does not apply)

Dates of Service

From: To: (NA if this does not apply)

Rank at Discharge

(NA if this does not apply)

Type of Discharge

(NA if this does not apply)

If other than honorable, explain

(NA if this does not apply)

Disclaimer and Signature: I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

First

Middle

Last

Resume Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Attach professional Resume here. L&R is more likely to consider applicants who have resumes prepared

Optional Photo Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Upload Pictures of your work

Do you have a OSHA CARD?

Yes
No

OSHA Card Upload

Drag & Drop Files, Choose Files to Upload

Upload OSHA Card Here

Do you have a Journeyman Licence(s)

Yes
No

Journeyman License(s)

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Upload License(s) Here

Additional Notes