phone: 480.621.8361, fax: 480.621.8513
3341 E. Queen Creek Road, Suite 109, Gilbert, AZ 85297

EMPLOYMENT APPLICATION

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.

If you prefer to fill out the application by hand, please download the form in .pdf format and mail it to Margaret Travillion, 3341 E. Queen Creek Road, Suite 109, Gilbert, AZ 85297.

I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE OR DOES CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT FOR A DEFINITE TERM. I ACKNOWLEDGE THAT IF HIRED BY THE COMPANY, EMPLOYMENT IS ON AN AT-WILL BASIS IN ACCORDANCE WITH STATE LAW. THIS MEANS THAT THE COMPANY IS FREE TO TERMINATE MY EMPLOYMENT AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCE NOTICE, IN ACCORDANCE WITH STATE LAW, AND ACCEPTANCE OF EMPLOYMENT IS NOT A CONTRACT OF EMPLOYMENT FOR ANY SPECIFIED TIME. SIMILARLY, I AM FREE TO TERMINATE MY EMPLOYMENT WITH THE COMPANY AT ANY TIME FOR ANY REASON. THIS AT-WILL PROVISION MAY BE MODIFIED OR WAIVED ONLY IN A WRITTEN AGREEMENT SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE COMPANY AND ME. I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL OR ITS ARBITRATION POLICY, IF ANY.

Position applied for:
Referred to L.I.F.E. by:
Name:
Telephone Number:
Alternate or Cellular Telephone Number:
Email Address:
Present Street Address (include City, State, Zip):
How long have you lived there (years/months)?
Previous Street Address (include City, State, Zip):
How long have you lived there (years/months)?
Desired Salary/Hourly Rate:
If under the age of 18, can you produce the necessary work certificate at the time of employment? Yes
No
Type of employment desired: Full-Time
Part-Time
Are you willing to work overtime? Yes
No
Date on which you can start work if hired:
Have you previously applied for employment with this company? Yes
No
If yes, when and where did you apply?
Have you ever been employed by this company? Yes
No
If Yes, please provide dates of employment, location, and reason for separation from employment.
INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS:
  1. Arizona, District of Columbia, Illinois, Missouri, Rhode Island and Utah applicants: Do not respond to the second question regarding arrests.
  2. All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court, or expunged, or convictions that resulted in referral to a diversion program.
Have you ever been plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above? Yes
No
Have you ever been arrested for any matters for which you are out on bail or on your own recognizance pending trial? Yes
No
CRIMINAL OFFENSES ONLY: If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.
Criminal convictions or arrests will not automatically disqualify an applicant from a particular job. The Company will consider the nature of the crime, its seriousness, whether the conviction(s) substantially relates to the position’s functions and qualifications, the frequency of convictions, the applicant’s age at the time of conviction, the time elapsed since the date of conviction or completion of jail sentence, the applicant’s entire work and educational history, and employment references and recommendations.
Have you ever initiated an act of violence in the workplace? Yes
No
If Yes, please provide the date(s) and explain so that individual circumstances can be considered. (A "Yes" answer will not necessarily disqualify you from employment.)
List all special technical skills that you feel qualify you for the job for which you are applying (e.g., computer programming/language, software, equipment operation, special tools or machines, etc.)
High School Name and Location:
Course of Study:
Did you graduate?
Number of Years Completed:
College Name and Location:
Course of Study:
Did you graduate?
Number of Years Completed:
Degree/Major:
Business/Technical/Trade or Post College School Name and Location:
Course of Study:
Did you graduate?
Number of Years Completed:
Degree/Major:
Honors Received:
Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
WORK EXPERIENCE: Please list the names of your present or previous employers in chronological order with present or last employer listed first. Account for all periods of time including any period of unemployment. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for future consideration from employment.
Employer Name:
Employer Address:
Type of Business:
Telephone:
Date Employed From:
Date Employed To:
Job Title:
Duties:
Supervisor's Name:
May we contact: Yes
No
If no, why not?
Starting Wage:
Final Wage:
Reason for Leaving:
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain.
Employer Name:
Employer Address:
Type of Business:
Telephone:
Date Employed From:
Date Employed To:
Job Title:
Duties:
Supervisor's Name:
May we contact? Yes
No
If No, why not?
Starting Wage:
Final Wage:
Reason for Leaving:
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain.
Employer Name:
Employer Address:
Type of Business:
Telephone:
Date Employed From:
Date Employed To:
Job Title:
Duties:
Supervisor's Name:
May we contact? Yes
No
If No, why not?
Starting Wage:
Final Wage:
Reason for Leaving:
What will this employer say was the reason your employment terminated?
How much notice did you give when resigning? If none, explain.
Please explain fully all gaps in your employment history in excess of one month.
Have you ever been terminated or asked to resign from any job? Yes
No
Has your employment ever been terminated by mutual agreement? Yes
No
Have you ever been given the choice to resign rather than be terminated? Yes
No
If you answered Yes to any of the above questions, please explain the circumstances of each occasion.
PROFESSIONAL REFERENCES:
Name:
Position:
Company:
Work Relationship (i.e. supervisor, co-worker):
Telephone:
Name:
Position:
Company:
Work Relationship (i.e. supervisor, co-worker):
Telephone:
PERSONAL REFERENCES:
Name:
Occupation:
Address:
Telephone:
Number of Years Known:
Name:
Occupation:
Address:
Telephone:
Number of Years Known:
Attach Your Cover Letter:
Attach Your Resume:
APPLICANT CERTIFICATION: I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

I understand that the Company may no have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law.

If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and in certain circumstances , my personal property.

I understand and agree that as a condition of employment to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, non-compete, and/or conflict of interest statement.

I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information.

If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States for this Company.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.

I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE.
Applicant Signature (type name):
Date:
© 2007 Lauren's Institute for Education