LIONEL HENDERSON & CO., INC.
4827 Laguna Park Drive, Suite 3; Elk Grove, CA95758
(916) 429-8601 – Fax (916) 429-6430
LH APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION (Please Print or Type):
Name (Last, First, MI): / Social Security Number:Present Street Address: / City: / State: / Zip Code:
Home Telephone Number: / Work Telephone Number: / Pager/Cell Number:
Are You At Least 18 Years Old? Yes No
Do You Have a Driver’s License? Yes No / State of Issue: / Number: / Class:
Have You Ever Been Discharged or Forced to Resign for Misconduct or Unsatisfactory Service?
Yes No
If Yes, Please Explain:
Have You Ever Been Convicted of a Criminal Offense (Felony or Serious Misdemeanor?
Yes No
If Yes, State the Nature of the Crime(s), when and where convicted and the disposition of the case:
Referred By: / Email Address Where We May Contact You:
EMPLOYMENT DESIRED (Please Print or Type):
Position Applying For: / Date You Can Start: / Desired Salary:Type Employment Desired: / Full Time / Part Time / On Call
Have You Ever Applied Or Worked With Lionel Henderson & Co., Inc Before? Yes No / If Yes, Please Tell Us When And Where:
Are There Other Names Under Which Your Employment, Educational Records, Reference, Or Other Information On The Application May Be Verified? Yes No
If Yes, List:
If You Are Hired, Can You Furnish Proof That You Are Either A US Citizen, Or Otherwise Legally Permitted To Work In The United States? Yes No
LHC EMPLOYMENT APPLICATION (CONTINUED)
Name (Last, First, MI):EDUCATION (Please Print or Type):
NOTE: Your educational records will be considered only to the extent that it is relevant to the position you are applying for.Name and Address of High School:
Academic Major(s):
Did You Graduate: Yes No GED / GPA/Rank in Class:
Name And Address Of Trade Schools Or Colleges (Include Military Schools):
Name/Address / From (MMM/YY) / To (MMM/YY) / Academic Major(s) / GPA / Degree (Specify) / Date (MMM/YY)
Computer and Skills Information (Please check your level of proficiency):
MS Word: Familiar Good Excellent / MS Excel: Familiar Good Excellent
MS Access: Familiar Good Excellent / MS Outlook: Familiar Good Excellent
Typing Speed (WPM): / 65 + WPM / 50 + WPM / 40 + WPM / 25 + WPM / < 25 WPM
List other computer or software applications that you have:
List other skills and/or training you feel would be an asset to LH:
LHC EMPLOYMENT APPLICATION (CONTINUED)
Name (Last, First, MI):EMPLOYMENT HISTORY (Please Print or Type):
NOTE: Begin with your present or most recent job. List all jobs in the past seven years. If you have not worked for any part of the past seven years, please list the reasons why (college, travel, etc). You may list any volunteer experience that relates to the position to which you are applying for. Each section must be completed. You may not use “see resume.” You may attach additional pages if necessary.
PRESENT OR PREVIOUS EMPLOYER: Still Employed: Yes No1. Employer Name and Address: Employed From: ______To: ______
May we contact them for a reference (if no, why?) / Yes No / Why:
Starting Base Pay: / Ending Base Pay:
Name and Title of Supervisor: / Telephone Number:
Position(s) Held:
Describe Duties:
Reason for Leaving:
PREVIOUS EMPLOYER
2. Employer Name and Address: Employed From: ______To: ______
May we contact them for a reference (if no, why?) / Yes No / Why:
Starting Base Pay: / Ending Base Pay:
Name and Title of Supervisor: / Telephone Number:
Position(s) Held:
Describe Duties:
Reason for Leaving:
LHC EMPLOYMENT APPLICATION (CONTINUED)
Name (Last, First, MI):PREVIOUS EMPLOYER
3. Employer Name and Address: Employed From: ______To: ______
May we contact them for a reference (if no, why?) / Yes No / Why:
Starting Base Pay: / Ending Base Pay:
Name and Title of Supervisor: / Telephone Number:
Position(s) Held:
Describe Duties:
Reason for Leaving:
PREVIOUS EMPLOYER
4. Employer Name and Address: Employed From: ______To: ______
May we contact them for a reference (if no, why?) / Yes No / Why:
Starting Base Pay: / Ending Base Pay:
Name and Title of Supervisor: / Telephone Number:
Position(s) Held:
Describe Duties:
Reason for Leaving:
LHC EMPLOYMENT APPLICATION (CONTINUED)
Name (Last, First, MI):PREVIOUS EMPLOYER
5. Employer Name and Address: Employed From: ______To: ______
May we contact them for a reference (if no, why?) / Yes No / Why:
Starting Base Pay: / Ending Base Pay:
Name and Title of Supervisor: / Telephone Number:
Position(s) Held:
Describe Duties:
Reason for Leaving:
EEO POLICY: LH maintains a policy of non-discrimination for all employees and applicants in every facet of the company’s operations in compliance with federal and state laws. LH hires, trains and promotes all qualified employees without unlawful discrimination on the basis of race, color, sex, age, religious creed, marital status, citizenship, national origin or disability. This policy also applies to disabled veterans and veterans of the Vietnam Era. If you wish to discuss LH’s Affirmative Action/Equal Employment Opportunity Policies and Programs, please contact a LH Human Resources Representative.
AUTHORIZATION: I certify that the facts contained on 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. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
PRINTED/TYPED NAME AND SIGNATURE OF INDIVIDUAL COMPLETING THE APPLICATION:
______
Printed Name Signature / DATE OF SIGNATURE:
HR 01-02
(Rev. 01/08)
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