Contact Info

5730 S. Bloomington Trail
Underwood, IN 47177

P: {|812-752-3173|}
F: {|812-752-7993|}

lks@c3bb.com
Application For Employment
Pre-Employment Questionnaire
An Equal Opportunity Employer
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Name: (First, Middle, Last)
Present Address:
Previous Address:
Phone No. (Main)
Phone No. (Secondary)
Are you 18 Years or Older?
Social Security No.
Have you been convicted of a felony or misdemeanor within the last 5 years? **
You will not be denied employment solely because of a conviction record, unless the offense is related to the job which you have applied.
Employment Desired
Position Desired
Date you can start:
Salary Desired:
Are you Currently Employed?
Describe:
If so, May we contact your current employer?
Have you ever worked for this company before?
If yes, when?
Employment History
Date: Month & Year
Name & Address of Employer
Salary
Position
Reason for leaving
From:
Starting:
To:
Ending:
Starting:
Ending:
From:
To:
Starting:
Ending:
Starting:
Ending:
Education
High School:
College:
Trade:
Name & Location of School
Double click here to add text.
No. of years attended
Did you Graduate?
Subjects Studied
**By submitting this application 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.
More Information may be requested to fulfill the application process.
Why Choose LKS Rose?
1. Quality.
2. We are a small, family owned and operated business where our customers are always on our minds.
"Every project is special"
Date of Birth:
YesNo
NoYes
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo