Application for Employment

Application for Employment
LAKUA, LLC is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.
Name*

First NameLast Name
Are you 18 years of age?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best Phone Number (Wrong or invalid numbers will void your application.)*

Area CodePhone Number
Email (Make sure you email is correct. Correspondence may be via email) *
Position Applying For*
Desired Pay*
Date Available*

MonthDayYear
Valid Drivers Licence #*
State DL is issued in*
Do you have a CDL? *
Please select below whether or not you are legally eligible for employment in the United States. (If offered employment, you will be required to provide documentation to verify eligibility.)
Eligible for employment?*

YesNo
Social Security # (You are not required to provide your Social Security # at this time. You will be required to provide a color copy of your Social Security Card card if offered employment.)
Social Security #
During the last ten years, have you ever been convicted of a crime other than minor traffic offense? (A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)
CONVICTED:*

YESNO
If YES, explain charges.
Field of Study / Degree
Education (select all that apply / may be required to provide documentation)*

some high schoolgraduated high school with diplomareceived GED credentialsome collegegraduated college with degree
Skills / Accomplishments
Work History
Upload Resume (optional)

Upload a File

Cancelof
Employer #1 (name of employer along with city and state)*
Time Employed (start and end date)*
Detail of Duties*
Employer #2 (name of employer along with city and state)*
Time Employed (start and end date)*
Detail of Duties*
Employer #3 (name of employer along with city and state)*
Time Employed (start and end dates)*
Detail of Duties*
References (no family members)
Reference #1*

First NameLast Name
Phone Number*

Area CodePhone Number
Reference #2*

First NameLast Name
Phone Number*

Area CodePhone Number
Reference #3*

First NameLast Name
Phone Number*

Area CodePhone Number
Feel free to add any additional comments to your application.
APPLICANT'S CERTIFICATION AND AGREEMENT

By signing below, I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize LAKUA, LLC to verify their accuracy and to obtain reference information on my work performance. I hereby release LAKUA, LLC from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.
Digital Signature. Type full Name.*
Date

MonthDayYear
Thank you for your interest in joining our team. Someone will be in contact with you within the next couple of days.
Should be Empty:

Application for Employment

Work History

References (no family members)