Careers Application Form

Name*

Address*

Email*

Phone*

Position applying for*

Working Time*

Full Time

Part Time

Weekends

How did learn about this company and position?

Have you ever been convicted of a crime or felony?

Yes

If Yes, please explain

Education*

Current or most recent work history? Please provide 3 along with experience and type of skills*

Name of Supervisor?

List 3 references with name, number and how are they related to you.

Applicant Consent

Please carefully read below and initial each one to indicate you understand and agree to the terms stated then sign this at the bottom.

I certify that all information I have supplied on this form is correct to the best of my knowledge. I understand that omission or providing deliberateness information will disqualify my application and if hired would serve grounds for dismissal.

I give consent to Lew and Associates Inc. to contact the employers listed on this form for my employment references. I authorize these individuals to provide truthful information regarding my employment and previous work experience. In doing so I waive liability against the employers and individuals contacted as my references, provided the information the supply is honest, factual and given without malice.

By checking box below you agree with the above mentioned statements are factual information provided.

I Agree