Simple Job Application Form

Employment Application
Litelab Corporation is an equal opportunity employer and does not lawfully discriminate on the basis of race, color, religion, sex, disability, national origin, sexual orientation, marital status or status as a disabled Vietnam Veteran (unless a bona fide occupational qualifications applies.)

Application must be completed in full.
Personal Information
Name

First Name MI Last Name
Current Address

Street Address

City State / Province

Postal / Zip Code Country
Email Address
Phone Number

Area Code Phone Number
Social Security Number
Are you at least 18 years of age?

Yes No
Are you a US citizen or an alien who has the right to remain and work in the U.S.? (You will be required to submit proof of lawful work status.)

Yes No
Employment Data
Position Desired
Date You Can Start

Month Day Year
Have you ever been previously employed by Litelab?

Yes No
If yes, when did you leave?

Month Day Year
How did you learn of Litelab?
Upload Resume

Education
Highest Grade Completed
High School

Name of Institution

Street Address Line 2

Location Graduate?
Vocational/Technical School

Name of Institution

Street Address Line 2

Location Graduate?
College/University

Name of Institution

Street Address Line 2

Location Graduate?
College/University

Name of Institution

Street Address Line 2

Location Graduate?
United States Military Service
Have you served in the U.S. Armed Forces?

Yes No
If yes, please provide rank

Employment History
Please list your three most recent positions.
Employer 1
Employer
Position Held
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
End Date

Month Day Year
Supervisors Name

First Name Last Name
May we contact him/her?

Yes No
Reason for Leaving
Employer 2
Employer
Position Held
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
End Date

Month Day Year
Supervisors Name

First Name Last Name
May we contact him/her?

Yes No
Reason for Leaving
Employer 3
Employer
Position Held
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
End Date

Month Day Year
Supervisors Name

First Name Last Name
May we contact him/her?

Yes No
Reason for Leaving

References
Please list 3 references who are not related to you, or are former employers.
Reference 1

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Years Known?
Reference 2

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Years Known?
Reference 3

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Years Known?

Applicant Acknowledgement
Accuracy of Information
I certify that the information contained in my application is complete and correct and understand that any falsification or misrepresentation of this information will disqualify me from consideration for employment or if hired may result in termination of employment.
I agree I disagree
References
I authorize Litelab Corporation and any independent agency acting on behalf of the company to request and receive information from various parties to assist in verifying the accuracy of my application and in evaluating my candidacy for employment. I release the parties supplying such information as well as Litelab Corporation, its owners, directors, affiliates, employees and agents from any and all liability and responsibility arising out of the release and receipt of this information.
I agree I disagree
Employment-at-Will
If I am hired, I understand and agree that my employment will be terminable at will; that is, either the company or I may terminate the employment relationship at any time for any reason or no reason, with or without notice. I understand that except for the company president, no company representative has the ability to alter this employment-at-will relationship and if hired, I will not rely on any such promises, representations or agreements regarding continued employment unless made in writing by the company president.
I agree I disagree
Enter Name

First Name Last Name
Signature

Clear
Enter Date

Month Day Year
All applications are active for a three (3) month period. If you wish to be considered
for later employment, you must submit a new application.
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Employment Application

Personal Information

Employment Data

Education

United States Military Service

Employment History

Employer 1

Employer 2

Employer 3

References

Applicant Acknowledgement

Accuracy of Information

References

Employment-at-Will