English Application – Lee Carolinas

Date*

Social Security Number*

Name*

First M.I. Last

Address*

Street Address Apt. City State ZIP Code

Home phone*

Business phone*

Cell phone*

Emergency phone*

Date of birth*

Gender

Race

Position desired*

Email address*

How were you referred to Lee?*

Name of referral source (if any)

First Last

Person to be notified in case of emergency

Name*

First Last

Phone*

Address*

Street Address Apt. City State ZIP Code

This application is intended for Lee applicants applying for positions of employment on Lee projects. Answer the questions to the best of your ability. All information will be treated confidentially

GENERAL INFORMATION

Do you have a valid Driver’s License?*

Yes
No

Are you legally authorized to work in the United States?*

Yes
No

Are you 18 years or older?*

Yes
No

Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodations?*

Yes
No

Please describe any accommodations required

Have you ever been convicted of a criminal offense?*

Yes
No

Date

Explain

An affirmative answer will not automatically disqualify you from being considered as a candidate for employment

Have you applied or worked for Lee before?*

Yes
No

Explain reason for leaving

Have you applied or work for English Construction or any of its subsidiaries?*

Yes
No

Explain reason for leaving

References (Not employers or relatives, 3 are required)

Reference 1

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Occupation

Email

Reference 2

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Occupation

Email

Reference 3

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Occupation

Email

Please include any other information you think would be helpful to Lee in considering you for employment, such as additional work experience, activities, accomplishments, etc.

TYPE OF WORK DESIRED

Indicate the position for which you are applying*

Do you wish to work*

Full Time
Part Time
Temporarily

If part time, specify hours or days*

What is your desired wages or salary requirement?*

Date available for work?*

Do you have any commitments to another employer that might affect your employment at Lee?

SKILLS: (list skills that you have that may help your employment opportunity at Lee)*

EDUCATIONAL DATA

Attach Resume if available

School 1

Name

Address

Street Address Address Line 2 City State ZIP Code

No. of Years Completed

Degree, Major, or Type of Course

School 2

Name

Address

Street Address Address Line 2 City State ZIP Code

No. of Years Completed

Degree, Major, or Type of Course

School 3

Name

Address

Street Address Address Line 2 City State ZIP Code

No. of Years Completed

Degree, Major, or Type of Course

MILITARY EXPERIENCE

Where you ever in the United States Armed Forces?*

Yes
No

Explain*

From*

To*

Highest Rank*

Briefly describe your duties*

EMPLOYMENT HISTORY

List employers in order from most recent

Employer 1

May we contact these employers?*

Yes
No

Name

Address

Street Address Address Line 2 City State ZIP Code

From

To

Supervisor’s Name

Your Job Title

Phone

Duties

Salary Start

Salary End

Employer 2

May we contact these employers?*

Yes
No

Name

Address

Street Address Address Line 2 City State ZIP Code

From

To

Supervisor’s Name

Your Job Title

Phone

Duties

Salary Start

Salary End

Employer 3

May we contact these employers?*

Yes
No

Name

Address

Street Address Address Line 2 City State ZIP Code

From

To

Supervisor’s Name

Your Job Title

Phone

Duties

Salary Start

Salary End

I hereby certify that the above statements are true and correct, to the best of my knowledge, and that any intentional misstatement of fact may result in Lee withdrawing its conditional offer of employment or dismissal.

Applicant’s Signature:*

Date*