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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.)
_____________________________________________________________________________________
_____________________________________________________________________________________
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Education
High School:...