LS Industries Application for Employment

LS Industries | 710 East 17th St. | Wichita, KS 67214-1312
P: (316) 265-7997 | TF: (800) 835-0218 | F: (316) 265-0013

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LS Industries Application For Employment

Applicants are considered for all positions without regard to race. color, religion. sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.

Date of Application
Position(s) Applied For
Referral Source: Advertisement Friend Relative Walk - In Employment Agency Other
Last Name:	First Name:	Middle Name:

Address:	City:	State:

Zip:	Phone:

Are you over 18? Yes No
Have you filled out an application here before? Yes No	If Yes, give date
Have you ever been employed here before? Yes No	If Yes, give date
Are you employed now? Yes No	May we contact your present employer? Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No (Proof of citizenship or immigration status may be required upon employment)
On what date would you be available for work?
Are you available to work? Full Time Part Time Shift Work Temporary
Are you a lay-off and subject to recall? Yes No
Can you travel if your job requires it? Yes No
Have you been convicted of a felony in the past 7 years? Yes No (Conviction will not necessarily, disqualify, applicant from employment)
If yes please explain?
Veteran of U.S. military service? Yes No	If yes what branch?
Indicate any languages that you speak read or write. Speak Fluent Good Fair Read Fluent Good Fair Write Fluent Good Fair
List professional, trade, business, or civic activities and offices held (You may be exclude those which indicate race, color, religion, sex or national origin)
Give address and telephone numbers of three references who are not related to you and are not previous employers.
Special Employment Notices to Disable Veterans, Vietnam Era Veterans, and Individuals With Physical or Mental Handicaps. Government contractors are subject to 38 USC 2012 of the veteran era veterans readjustment act of 1974 which requires that they take affirmative action to employ and advance employment qualified disabled veterans and veterans of Vietnam era, and section 503 of the rehabilitation Act of 1973 as amended which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disable veteran, or have a physical handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodations to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.
If you wish to be identified, please check box below. Handicapped Individual Disabled Veteran Vietnam Era Veteran

Employment Experience

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.

Employer Phone Address

Job Title Supervisor

Dates Employed: From To

Hourly Rate/ Salary : Starting Final

Reason for leaving

Work Performed:

Employer Phone Address

Job Title Supervisor

Dates Employed: From To

Hourly Rate/ Salary : Starting Final

Reason for leaving

Work Performed:

Employer Phone Address

Job Title Supervisor

Dates Employed: From To

Hourly Rate/ Salary : Starting Final

Reason for leaving

Work Performed:

Employer Phone Address

Job Title Supervisor

Dates Employed: From To

Hourly Rate/ Salary : Starting Final

Reason for leaving

Work Performed:

Education

School name:

Elementary Highest Grade Completed

High School Highest Grade Completed

Describe course of study:

Did you receive a Diploma? Yes No

College/University Years Completed

Describe course of study:

Did you receive a Degree? Yes No

Describe specialized training, apprenticeship, skills, and extra Curricular Activities:

Honors Received:

State any additional information you feel may be helpful to us in considering your application.

Rate yourself on a scale of 1-10: 1-3 Good, 4-7 Average, 8-10 poor

FOR SHOP APPLICANTS ONLY:

English Spoken English Reading

English Writing Mechanical Ability

Working with others Electrical Ability

Mathematical Ability Blueprint Reading Ability

Welding Ability

Do you have experience with:

Computers Yes No

Calculators Yes No

Applicant's Statement:

By checking this box you certify that the answers given are true and complete to the best of my knowledge.

By checking this box you authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment.

By checking this box, in the event of employment, you understand that false or misleading information given in your application or interview(s) may result in discharge. You understand also, that you are required to abide by all rules and regulations of the company.