Application LS

Job Application for (required)*

Today's Date

Are you seeking: employment?Full-timePart-timeTemporary

When could you start work?

Last Name*

First Name*

Middle Name

Telephone Number*

Present Street Address

City*

State*

Zip Code*

Are you 18 years of age or older? YesNo

(If you are hired, you may be required to submit proof of age.)

If hired, can you furnish proof you are eligible to work in the U.S.? YesNo

Have you ever applied here before? YesNo

If yes, when?

Were you ever employed here?YesNo

If yes, when?

Have you ever been convicted of any law violation? Include any plea of "guilty" or "no contest." Exclude minor traffic violations.) YesNo

If yes, give details

(A conviction will not necessarily disqualify an applicant for employment.)

If employed, do you expect to be engaged in any additional business or employment outside of our job? YesNo

If yes, give details

For Driving Jobs Only: Do you have a valid driver's licenseYesNo

Driver's License Number

Class of License

State Licensed In

Have you had your driver's license suspended or revoked in the last 3 years?YesNo

If yes, give details

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)

LIST NAME AND ADDRESS OF SCHOOLS

Number of Years Completed

Diploma/ Degree/ Certificate

Subjects Studied

High School or GED

College or University

Vocational or Technical

What skills or additional training do you have that relate to the job.for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

CONSENT FOR DRUG/ALCOHOL TESTING

If you are offered but pending employment with LS Traffic Control in the interest of safety for all concerned, you will be required to take a urine test for drug and/or alcohol use,

have been fully informed of the reason for this urine test for drug and/or alcohol It understand what I am being tested for), the procedure involved, and do hereby freely give my consent. In addition, I understand that the results of this test will be forwarded to my potential employer and become part of my record.

If this test is positive, and for this reason I am not hired, I understand that l will be given the opportunity explain the results of this test. I hereby authorize these test results to be released to: LS Traffic Control

APPLICANT

Printed Name

Date

NON-DOT DRUG SCREEN TEST ALCOHOL BREATHE TEST

Date

Name

COPY OF DRIVER’S LICENSE

Name

Phone Number

Emergency contact

Name

Phone Number

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer