LKCS » Job Application

4130 Plank Road
Peru, IL 61354
815-223-0391
fax 815-223-6885
toll free 866-552-7866
Contact Us | Directions

First Name:

Last Name:

E-mail:

Address:

City:

State:

Zip:

Phone:

Position:

Expected Pay:

Would you accept full-time work?

Yes No

Would you accept part-time work?

Yes No

On what date would you be available for work?

Have you ever been employed here before?

No Yes

If yes, Date:

Special training or skills (languages, machine operations,etc.) that would be of special benefit in the job for which you are applying:

Are you legally eligible for employment in the United States?

Yes No (If yes, proof is required)

Are you of legal age to work in the United States?

Yes No

Educational Background

Grammar School
Name:
Address:
City/State/Zip
Course of Study
Did you graduate?	Yes No
Degree or diploma:

High School
Name:
Address:
City/State/Zip
Course of Study
Did you graduate?	Yes No
Degree or diploma:

College
Name:
Address:
City/State/Zip
Course of Study
Did you graduate?	Yes No
Degree or diploma:

Graduate School
Name:
Address:
City/State/Zip
Course of Study
Did you graduate?	Yes No
Degree or diploma:

Vocational Training-other
Name:
Address:
City/State/Zip
Course of Study
Did you graduate?	Yes No
Degree or diploma:

Membership in professional or civic organizations:
(Exclude those which may disclose your race, color, religion or national origin.)

Employment Experience
( Please check the box in front of the employer(s) you do not want us to contact.) List your most recent employer first.

	Employer:
	Address:
	City/State/Zip:
	Phone:
	Job Title:
	Supervisor:
	Dates Employed:	From:
	Dates Employed:	To:
	Hourly rate/salary:	starting:
	Hourly rate/salary:	final:
	Work Performed:
	Reason for Leaving:

	Employer:
	Address:
	City/State/Zip:
	Phone:
	Job Title:
	Supervisor:
	Dates Employed:	From:
	Dates Employed:	To:
	Hourly rate/salary:	starting:
	Hourly rate/salary:	final:
	Work Performed:
	Reason for Leaving:

	Employer:
	Address:
	City/State/Zip:
	Phone:
	Job Title:
	Supervisor:
	Dates Employed:	From:
	Dates Employed:	To:
	Hourly rate/salary:	starting:
	Hourly rate/salary:	final:
	Work Performed:
	Reason for Leaving:

	Employer:
	Address:
	City/State/Zip:
	Phone:
	Job Title:
	Supervisor:
	Dates Employed:	From:
	Dates Employed:	To:
	Hourly rate/salary:	starting:
	Hourly rate/salary:	final:
	Work Performed:
	Reason for Leaving:

Personal References
(other than family members or previous employers)

Name:
Address:
City/State/Zip:
Phone:

Name:
Address:
City/State/Zip:
Phone:

Name:
Address:
City/State/Zip:
Phone:

Please by sure to sign and date this application. Thank you for your interest in our company.
I understand that the Immigration Reform and Control Act of November 6, 1986 requires me to prove the legality of my residency or citizenship. I am also aware that the failure to provide such proof at the time of request may legally force my termination. to the best of my knowledge the information contained on this application is true. I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and this company for either employment or the provision of any benefits; and further understand that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and an authorized representative of the company.
Name:
Date: