Finding employment

Finding employment

Page 1 of 4

Lifekeepers LLC

Employment Application
Applicant Information
Full
Name:

Date:
Last

First

M.I.

Address:
Street Address

Apartment/Unit #

City

State

ZIP Code

***************************************************************************************************************************** ***********************************************

Phone:

______________________________

Valid Drivers License:

____________

Date Available to Work:

E-mail Address:

_______________________________

__________________

Vehicle:

________________________

Referred By:

Auto Insurance:

_________________

________________________________

****************************************************************************************************************************************************************************

YES

NO

Are you a citizen of the United States?

YES

NO

YES

NO

Full

Part

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

NO

Are you 18 years of age?

Do you have a high school diploma or GED?
YES

NO

Ever applied with us previously?

Seeking Full-time or Part-time employment?
YES

NO

Able to lift at least 25 lbs consistently?

Position
applied for:

_____________________

Salary
desired:

___________

***************************************************************************************************************************** ************************************************

Have you ever been convicted of a crime or
are subject to a pending criminal charge?
If yes, explain:

YES

NO

(NOTE: No applicant will be denied employment based solely on
the grounds of a conviction or pending criminal charge.)

_____________________________________________________________________________________

_____________________________________________________________________________________

Page 2 of 4

Education
High School:...

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