Employment Application

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Lex Products is committed to equal opportunity and is dedicated to a policy of non discrimination in employment based on race, color, age, sex, sexual orientation, disability, or national origin.

Applicant Information
Name:
Phone:
Street Address:
Apt/Unit #:
City:
State:
Zip:
Email:
Social Security No.:

Position Applied for:
Date Available:
Desired Salary:
Are you a citizen of the United States?	If no, are you authorized to work in the U.S.?
Have you ever worked for Lex?	If so, when?
Have you ever been convicted of a felony?	If yes, explain:

Education
High School:
Address:
Dates Attended:	to
Did you graduate?	Degree:
College:
Address:
Dates Attended:	to
Did you graduate?	Degree:
Other:
Address:
Dates Attended:	to
Did you graduate?	Degree:

References (Please list three professional references.)
Name:
Relationship:
Company:
Address:
Phone:

Name:
Relationship:
Company:
Address:
Phone:

Name:
Relationship:
Company:
Address:
Phone:

Previous Employment
Company:
Address:
Phone:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Duration:	From: To:
Reason for leaving:
May we contact your previous supervisor for a reference?

Company:
Address:
Phone:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Duration:	From: To:
Reason for leaving:
May we contact your previous supervisor for a reference?

Company:
Address:
Phone:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
Duration:	From: To:
Reason for leaving:
May we contact your previous supervisor for a reference?


Military Service
Branch:
Duration:	From: To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

Disclaimer and Signature
By initialing below, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Applicants Initials:
Date:

Employment Application

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