LaCROSSE FURNITURE CO.
1215 OAK STREET P. O. BOX 99 LACROSSE, KANSAS 67548

Application for Employment

LaCrosse Furniture Co. is an Equal Opportunity Employer. Perspective employees will receive consideration of employment without discrimination of race, creed, color, sex, age, national origin, martial status, handicap or veteran status.

Note: All fields shown in red are required.
PERSONAL
Last Name First Middle Initial
Date
Street Address P.O. Box
Home Phone No.
( )  
City State Zip Code
Work Phone No.
( )  
Position Applied For
When will you be available to begin work?
Email Address
Special training or skills (cutting, sewing, woodworking, upholstering, computer applications, office, fork lift operation, etc.)
Pay Expected
Apart from absence for religious observance, are you available for full-time work, including required overtime?
[ ]  

Yes

[

]

  

No
Are you legally eligible for employment in the United States? (If yes, verification will be required.)
[ ]   Yes [ ]   No
Have you ever applied for employment with us?
[ ]   Yes [ ]   No If Yes: Month and Year  

Have you ever worked for us?
[ ]   Yes [ ]   No If Yes: From     To  
Supervisor
How did you hear of our company?

EDUCATION
SCHOOL NAME AND LOCATION OF SCHOOL COURSE OF STUDY
College

High School

Other


Please give an accurate complete full-time and part-time employment record. Start with present or most recent.

EMPLOYMENT
1. Company Name
Telephone Number
( )  
Address
Employed Status
State Month and Year
From To
Name of Supervisor
Weekly Pay
Start Last
State Job Title and Describe Your Work
Reason for Leaving
2. Company Name
Telephone Number
( )  
Address
Employed Status
State Month and Year
From To
Name of Supervisor
Weekly Pay
Start Last
State Job Title and Describe Your Work
Reason for Leaving
3. Company Name
Telephone Number
( )  
Address
Employed Status
State Month and Year
From To
Name of Supervisor
Weekly Pay
Start Last
State Job Title and Describe Your Work
Reason for Leaving
4. Company Name
Telephone Number
( )  
Address
Employed Status
State Month and Year
From To
Name of Supervisor
Weekly Pay
Start Last
State Job Title and Describe Your Work
Reason for Leaving
5. Company Name
Telephone Number
( )  
Address
Employed Status
State Month and Year
From To
Name of Supervisor
Weekly Pay
Start Last
State Job Title and Describe Your Work
Reason for Leaving

We may contact the employers listed above unless
You indicate those you do not want us to contact.

 DO NOT CONTACT: Employer(s) No.
Reason:

DO NOT ANSWER ANY QUESTION IN THIS SECTION UNLESS THE BOX IS CHECKED.
Are you over 18 years old? [ ] Yes [ ] No If No, employment is subject to verification of minimum legal age.
Have you ever been bonded? [ ] Yes [ ] No If Yes, with what employer?
State names of relatives and friends currently working for us.

The information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or omission of the fact on this application may result in my dismissal.

THIS APPLICATION DOES NOT CONSTITUTE A CONTRACT OF EMPLOYMENT EXPRESSED OR IMPLIED.  EMPLOYMENT IN THIS COMPANY IS AT WILL, PERMITTING THE EMPLOYEE OR COMPANY TO TERMINATE THE EMPLOYMENT RELATIONSHIP FOR ANY REASON AT ANY TIME.

No oral or written modification to this policy is allowed.

Date Signature

website design by:
RAM Enterprises
Copyright ©2012 - RAM Enterprises - All Rights Reserved.

Website Updated
May 17, 2012