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Employment Application


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PERSONAL INFORMATION


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EMPLOYMENT DESIRED



Are You Employed?:
Yes     No
May We Contact Your Present Employer?:
Yes     No
Ever Applied To LCSI Before?:
Yes     No

EDUCATION



GENERAL

FORMER EMPLOYERS

EMPLOYER


EMPLOYER


EMPLOYER

REFERENCES - (KNOWN AT LEAST ONE YEAR)



MISCELLANEOUS INFORMATION


 
DO YOU HAVE ANY MEDICAL, PHYSICAL, EMOTIONAL CONDITIONS OR PERSONAL CONFLICTS THAT WOULD PREVENT YOU FROM PERFORMING DAILY ROUTINE DUTIES OF SUPERVISING CHILDREN AGES 3 TO 14? DUTIES INCLUDE, BUT ARE NOT LIMITED TO: WALKING, RUNNING, STANDING, SITTING, READING, WRITING, AND LIFTING (NOT TO EXCEED 40 LBS.):    Yes     No

IF YES, PLEASE DESCRIBE IN DETAIL:

BACKGROUND

Yes     No

 

AUTHORIZATION

I HEREBY CERTIFY THAT THIS INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I ALSO AUTHORIZE A COMPLETE BACKGROUND CHECK, INCLUDING VERIFICATION OF EDUCATION AND EMPLOYMENT, REFERENCE CHECK AND CRIMINAL BACKGROUND CHECK. IF HIRED, ANY FALSIFICATION OF INFORMATION HEREIN OR ON THIS APPLICATION FORM CAN RESULT IN IMMEDIATE DISMISSAL.

“I CERTIFY THAT THE FACTS CONTAINED IN THIS 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.”

 


Corporate office: 1141 N. Robinson, Suite 404, Oklahoma City, OK 73103 / (405) 236-2069 / (405) 236-3909 fax