Employement Job Application

On-line Job Application

Lakes & Prairies Community Action Partnership, Inc., is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

Position Applying for:

Date of Application:

Last Name:

First Name:

Middle Name:

Current Address:

City:

Zip:

State:

Telephone Number:

Alternate Telephone Number:

How did you hear about us?

Are you legally eligible to work in the United States?

YES

(Proof of eligibility will be required upon offer of employment)

Are you over the age of 18 years?

YES

(If no, you may be required to provide authorization)

Can you with or without reasonable accommodation perform the essential functions of this job?

YES

Have you ever worked for Lakes & Prairies before?

(If yes, please give date.)

Have you ever been convicted of a felony?
(A conviction will not necessarily disqualify you.)

YES

If yes, please explain:

Do you have a valid driver’s license?
(For driving positions only.)

YES

Have you been convicted of any moving violations in the past five years?

YES

If yes, please explain:

On what date would you be available to work?

EDUCATION HISTORY

Last High School (HS) GED School. Give the school’s name, city, state, ZIP code, and year diploma or GED received.

Mark Highest Level Completed:

HS/GED

AA/AS

BA/BS

Masters

Doctoral

Colleges & Universities attended. Do not attach a copy of transcript unless requested.

Name:

City:

State:

Zip:

TOTAL CREDITS EARNED

Semester:

Quarter:

DEGREE &
YEAR RECEIVED

MAJOR(S)

Name:

State:

Zip:

City:

TOTAL CREDITS EARNED

Semester:

Quarter:

MAJOR(S)

DEGREE &
YEAR RECEIVED

Name:

City:

State:

Zip:

TOTAL CREDITS EARNED

Semester:

Quarter:

DEGREE &
YEAR RECEIVED

MAJOR(S)

Please list any academic honors, scholarships, offices held, etc. (Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities or veteran status, or any other legally protected class.)

Describe any specialized training, apprenticeships, licenses or skills.

EMPLOYMENT HISTORY (Begin with the current or most recent employer. Do not exclude any employment. Include any applicable temporary employment. Send an additional e-mail with the information below to: HR Director if necessary. Previous salaries or wages will not be used to determine compensation at LAKES & PRAIRIES.)

Current Employer:

Address:

Phone:

Employment Start Date:

Starting Salary:

Ending Salary:

Position Title:

Description of duties and responsibilities:

Name and Title of Supervisor:

May we contact supervisor?

YES

First Previous Employer:

Address:

Phone:

Employment start date:

Employment end date:

Starting Salary:

Ending Salary:

Position Title:

Description of duties and responsibilities:

Name and Title of Supervisor:

May we contact supervisor?

YES

Reason for leaving and explanation:

Next Previous Employer:

Address:

Phone:

Employment start date:

Employment end date:

Starting Salary:

Ending Salary:

Position Title:

Description of duties and responsibilities:

Name and Title of Supervisor:

May we contact supervisor?

YES

Reason for leaving and explanation:

Next Previous Employer:

Address:

Phone:

Employment start date:

Employment end date:

Starting Salary:

Ending Salary:

Position Title:

Description of duties and responsibilities:

Name and Title of Supervisor:

YES

May we contact supervisor?

Reason for leaving and explanation:

*PLEASE READ CAREFULLY BEFORE SUBMITTING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsifications, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by LAKES & PRAIRIES COMMUNITY ACTION PARTNERSHIP, INC. (hereinafter referred to as “LAKES & PRAIRIES”) that such employment with LAKES & PRA