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Lubbock Glass & Mirror
Careers
Application for Employment
Equal Opportunity Employer
Date
Name
Present Address
Permanent Address
Phone Number
E-Mail
Referred By
Employment Desired
Posistion
Date you Can Start
Are You Employed Now?
Yes
No
Where?
Ever Applied to this Company Before?
Yes
No
When?
Education
High School
Last Year Completed
1
2
3
4
Did You Graduate?
Yes
No
Subjects Studied
College
Last Year Completed
1
2
3
4
Did You Graduate?
Yes
No
Subjects Studied
Trade, business or Correspondence School
Last Year Completed
1
2
3
4
Did You Graduate?
Yes
No
Subjects Studied
General
Subjects of Special Study or Research Work
Special Training
Special Skills
U.S. Military Service
Rank
Former Employers
Begin with the most recent employer.
Employer 1
From
To
Name and Address of Employer
Position
Reason For Leaving
Employer 2
From
To
Name and Address of Employer
Position
Reason For Leaving
Employer 1
From
To
Name and Address of Employer
Position
Reason For Leaving
Employer 4
From
To
Name and Address of Employer
Position
Reason For Leaving
References
List below three persons not related to you, whom you have known at least one year.
Reference 1
Name
Position
Phone
Years Aquainted
Reference 2
Name
Position
Phone
Years Aquainted
Reference 3
Name
Position
Phone
Years Aquainted
AUTHORIZATION
“I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities act (ADA) and other relevant federal and state laws.”
I consent this information is correct and true.
Yes
Date
Full Name
Submit