EMPLOYEE APPLICATION

LAFAYETTE

MEMORIAL PARK

CEMETERY & MAUSOLEUM

Employment Application

Last Name:

First Name:

Middle Initial:

Street Address:

Apt/ Suite:

City:

State:

Zip Code:

Phone:

Email:

Available Start Date:

Position You Are Applying For:

Date of Birth:

Are you a U.S. citizen?

If NO, explain:

Have you ever worked for this company?

If YES, when?

Have you ever been convicted of a felony?

If YES, explain:

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PREVIOUS EMPLOYMENT

Company Name 1:

Phone:

Address:

Job Title:

Starting Pay:

Ending Pay:

Start Date:

End Date:

Reason for Leaving?

May we contact your supervisor for a reference?

Company Name 2:

Phone:

Address:

Job Title:

Starting Pay:

Ending Pay:

Start Date:

End Date:

Reason for Leaving?

May we contact your supervisor for a reference?

Company Name 3:

Phone:

Address:

Job Title:

Starting Pay:

Ending Pay:

Start Date:

End Date:

Reason for Leaving?

May we contact your supervisor for a reference?

New Field

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REFERENCES

Reference Name 1:

Relationship:

Address:

Phone:

Email:

Reference Name 2:

Relationship:

Address:

Phone:

Email:

Reference Name 3:

Relationship:

Address:

Phone:

Email:

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EDUCATION

Highest level of education completed:

School/ College:

Degree/ Diploma received:

Start Date:

End Date:

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Hello

By checking this box I certify that my answers are true, correct and complete to the best of knowlege. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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Employment Application