Langford and Low Employment Application

WELCOME! We deeply appreciate your interest in Langford & Low, Inc. and assure you that we are sincerely interested in your qualifications. Your cooperation in completing this employment application fully and accurately will supply us with information required for our records. All persons shall have the opportunity to obtain employment without discrimination because of race, color, religion, national origin, citizenship, sex, age, disability/handicap, veteran status, military status, or other impermissible data. Note: Fields marked with a * are required.

Personal Information
Name

First Name:	*

Last Name:	*

Middle Initial:
Address and Telephone

Address:	*

City:	*

State:	*

Zip:	*

Telephone Number:	*

E-mail Address:	*
Previous Address

Date From:

Date To:

Street:

City:

State:

Zip:

Country:
Position
Position Desired:	*

If other, please explain:

What unique skills do you bring to this position:	*

Salary Requirements:	*

Date available to begin work:	*

Date of application:	*
Are you over the age of 18 years?	*
Are you legally authorized to work in the U.S.?	*
Are you capable of performing the essential functions of this position?	*
Have you previously worked for Langford & Low?	*
Have you served in the armed forces?	*

If yes, which branch:
Do you have any outside commitments that might affect your employment with us?	*

If yes, please explain:
Are you able to work nights if required?	*
Are you able to work weekends if required?	*
Do you possess a valid driver's license?	*
Are you willing to travel for work?	*
Do you have reliable transportation?	*

If no, please explain:
Education
High School or GED

School Name and Address:	*

Highest Grade Completed:	*
Graduated?	*
College

School Name and Address:

Course of Study:

Years Completed:
Graduated?

Degree Earned:
Graduate School

School Name and Address:

Course of Study:

Years Completed:
Graduated?

Degree Earned:
Technical School

School Name and Address:

Course of Study:

Years Completed:
Graduated?

Degree Earned:
Employment History
By completing this application, I authorize Langford and Low to contact my previous employers and other references provided on my application. I also authorize my previous employers and my references to give any information regarding my previous employment or other qualifications for the position for which I have applied
Please list your last three (3) positions held at previous employers.
Have you been unemployed for two months or more?	*
Employer 1

Employer's Name:	*

Address:	*

Job Title:	*

Responsibilities:	*

Starting Date:	*

Ending Date:	*

Supervisor's Name:	*

Supervisor's Phone #:	*

Reason for Leaving:	*

Starting Salary:	*

Ending Salary:	*
Employer 2

Employer's Name:

Address:

Job Title:

Responsibilities:

Starting Date:

Ending Date:

Supervisor's Name:

Supervisor's Phone #:

Reason for Leaving:

Starting Salary:

Ending Salary:
Employer 3

Employer's Name:

Address:

Job Title:

Responsibilities:

Starting Date:

Ending Date:

Supervisor's Name:

Supervisor's Phone #:

Reason for Leaving:

Starting Salary:

Ending Salary:
Professional References
Do not list a relative or anyone in the service of Langford & Low
Reference 1

Full Name of Reference:	*

Address:	*

Telephone Number:	*

Connected with what business:	*

Position:	*
Reference 2

Full Name of Reference:

Address:

Telephone Number:

Connected with what business:

Position:
Reference 3

Full Name of Reference:

Address:

Telephone Number:

Connected with what business:

Position:
General Information
Have you been convicted, pleaded guilty or pleaded nolo contendere to a felony?	*
Have you been convicted, pleaded guilty or pleaded nolo contendere to a crime involving dishonesty?	*

If YES to either question, please provide date, place and nature of conviction:
	Please note that conviction will not necessarily bar you from being considered for employment.
How did you hear about the job opening?

If you chose other, please specify:
Are you looking to be employed:	*

Do you have interests or hobbies realted to this position?

Is there any other relevant information we should know about?

What would you like to achieve by working at Langford & Low?
By submitting this application, I am certifying that the information contained in the application is true and accurate. I understand that any false statements, omissions, or misrepresentations in this application may result in my failure to be considered for employment, or if I have been hired, in my immediate termination. I acknowledge that if employed, I will be an "employee at will," and that both Langford and Low and I will have the right to terminate my employment at any time, with or without cause

Personal Information

Name

Address and Telephone

Previous Address

Position

Education

High School or GED

College

Graduate School

Technical School

Employment History

Employer 1

Employer 2

Employer 3

Professional References

Reference 1

Reference 2

Reference 3

General Information