PERSONAL INFORMATION

Email*

First Name*

Middle Initial*

Last Name*

Phone No.*

Cell Phone No.* Use the same number if you have no other number

Alternate Phone No.* Use the same number if you have no other number

Address*

City & State*

Have you previously worked for Lee’s Welding Service LLC?*

YesNo

If so, when?

Have you ever worked under another name?*

YesNo

If so, list:

Can you, after employment, provide evidence of your identification and authority to work in the U.S.?*

YesNo

JOB APPLYING FOR:

Position Desired

Years of Experience in Position:

Date Available:

Are you presently employed?*

YesNo

If yes, for how long?

May we contact your present employer?*

YesNo

EMPLOYMENT HISTORY:

(Your application will not be considered unless you give complete information)

Employment One:

(Most recent employment first)

Company Name

Company Address

Date From/To

Supervisor's Name

Position Held

Rate of Pay

Do you have another previous employment?*

YesNo

Employment Two:

Company Name

Company Address

Date From/To

Supervisor's Name

Position Held

Rate of Pay

Do you have another previous employment?*

YesNo

Employment Three:

Company Name

Company Address

Date From/To

Supervisor's Name

Position Held

Rate of Pay

Do you have another previous employment?*

YesNo

Employment Four:

Company Name

Company Address

Date From/To

Supervisor's Name

Position Held

Rate of Pay

PERSONAL HISTORY:

Have you ever been convicted of a crime, excluding misdemeanors?* A conviction record will not necessarily eliminate employment. Factors such as age at the time of the offense, seriousness and nature of the violation, and rehabilitation will be considered.

YesNo

If yes, describe in full:

EDUCATION:

Describe any special training:

Do you have special skills or operate special machinery or equipment?*

YesNo

If yes, specify:

REFERENCES:

Give the names and addresses of two (2) people (no relatives) you have worked with and whom we may contact for a reference if necessary.

Reference One:

Name*

Address

Phone No.*

Occupation*

Reference Two:

Name*

Address

Phone No.*

Occupation*

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE YOU SIGN AND RETURN

RELEASE OF INFORMATION

Lee’s Welding Service LLC., in considering my application for employment, may verify the information in this application and obtain additional background information. I authorize all persons, schools, companies and law enforcement agencies to supply any information concerning my background that they may have personal or otherwise and I release all such parties form liability from any damage which may result from furnishing such information to the company.

If you have read and understand the statement above, please check the box.

DRUG SCREENING POLICY AND STATEMENT

I understand that Lee’s Welding Service LLC. requires a drug screening test as a part of its selection and hiring process. I also understand that such drug screening will consist of the taking of urine, or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If the results do not indicate a satisfactory specimen and negative results, I will be disqualified from further consideration for employment. I give my consent to Lee’s Welding Service LLC. to administer any drug screening procedures to me, and to use the results in further determining my employment. I acknowledge and agree that I will be subject to drug screening upon reasonable suspicion as a condition of my employment.

If you have read and understand the statement above, please check the box.

CONDITIONS OF EMPLOYMENT

I understand that if I am employed, any misrepresentation or omission of material facts on this application is sufficient cause for dismissal. I agree to conform to the rules and regulations of Lee’s Welding Service LLC, and understand that if hired, I will be a "terminable-at-will" employee, and that my employment and compensation can be terminated with or without cause and with or without notice, at any time at the option of either Lee’s Welding Service LLC., or myself.

If you have read and understand the statement above, please check the box.

REASONABLE ACCOMODATION

Any applicant with a disability who need reasonable accommodation in any step of the hiring process to help him or her to demonstrate his or her qualifications to perform the duties of the job for which the individual is applying, may request such accommodation at any time during the employment process.

I understand that this application is good for sixty (60) days from today's date. If I still desire a position after this application expires, it will be my duty to fill out a new application and file it with Lee’s Welding Service LLC.

I certify by my signature that the information contained in this application is true and correct.

Date of Application*

Signature of Applicant

Build Your Career with Lee’s Welding Service

PERSONAL INFORMATION

JOB APPLYING FOR:

EMPLOYMENT HISTORY:

PERSONAL HISTORY:

EDUCATION:

REFERENCES:

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE YOU SIGN AND RETURN

RELEASE OF INFORMATION

DRUG SCREENING POLICY AND STATEMENT

CONDITIONS OF EMPLOYMENT

REASONABLE ACCOMODATION