L&M Pre-Employment Questionnaire
Equal Opportunity Employer

Full Name *
Email Address *
Phone *
Current Home Address
Referred By
Position Applying For
Date You Can Start
Salary Desired
Are you currently employed?
Yes
No
May we inquire of your present employer?
Yes
No
Have You Ever Applied To This Company Before?
Yes
No
If So, When?

Name and Location of High School Attended

Years Attended
Did You Graduate High School
Yes
No
Subjects Studied in High School
Name and Location of College Attended
Years Attended
Did You Graduate College
Yes
No
Subjects Studied In College
Name and Location of Trade, Business, or Correspondence School Attended
Years Attended
Did You Graduate
Yes
No
Subjects Studied
Any other special training or skills?
US Military or Naval Service?
Rank
Name and Address of Former Employer #1
Salary and Position
Reason For Leaving
Employment began and end dates
Name and Address of Former Employer #2
Salary and Position
Reason For Leaving
Employment began and end dates
Name and Address of Former Employer #3
Salary and Position
Reason For Leaving
Salary and Position
Reference #1: Name, Phone Number, and years known
Reference #2: Name, Phone Number, and years known
Reference #2: Name, Phone Number, and years known
“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.

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 understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.”

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.