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Employment Application
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Do you have a family member (parents, spouse, brother, sister, son, daughter, father or mother-in-law, brother or sister-in-law, son or daughter-in-law) who serves on LifeTime's Board of Directors?
Yes
No
Are You Looking for Full-Time or Part-Time Work?
Full-Time
Part-Time
Position Desired
How did you hear about our agency?
Have you ever been interviewed for employment with us?
Yes
No
If Yes, when?
Position
Pay Expected
Pay Type
Per Hour
Per Week
Per Month
Per Year
Apart from absence for religious observances, are you available for full-time work?
Yes
No
If not, what days/hours can you work?
Will you work overtime if asked?
Yes
No
Are you legally eligible for employment in the United States?
Yes
No
When will you be available to begin work?
Elementary School
High School
# of Years Completed
Did You Graduate?
Yes
No
College
# of Years Completed
Did You Graduate?
Yes
No
Course of Study
Please list other special training or skills that you believe qualify you for the position.
Membership in professional or civic organizations
With the exception of misdemeanors and summary offenses, have you been convicted of a crime in the past ten years which has not been annulled, expunged, or sealed by a court?
Yes
No
If Yes, describe in full.
State names of relatives and friends working for us other than your spouse.
Besides the local newspaper, where have you looked for job openings?
Company Name
Company Address
Company Phone
Started Job (date)
Ended Job (date)
Supervisor Name
Your Name While Employed
State Job Title, and Describe Your Work
Weekly Pay Start
Weekly Pay End
Reason For Leaving
Company Name
Company Address
Company Phone
Started Job (date)
Ended Job (date)
Supervisor Name
Weekly Pay End
Weekly Pay Start
Reason For Leaving
Your Name While Employed
State Job Title, and Describe Your Work
Reference 1 Name
Address
Phone
Reference 2 Name
Address
Phone
Reference 3 Name
Address
Phone
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