Application for Employment

Neils Lunceford Employee Application

First name

Middle Initial

Last name

Phone Number

Are you 18 years or older?

Yes

Are you legally allowed to work in the USA?

Yes

Physical Address

Physical Street Address

State

Zip Code

City

Your Mailing Address

Mailing Street Address

State

Zip Code

City

Most jobs at Neils Lunceford require driving a vehicle

Do you have a valid Driver's License?

Yes, a Colorado License

Yes, an Out-of-State License

Have you had any, any at all, moving violations in the last 5 years?

Yes

Please Note: Employees expected to drive for the company will need to furnish a Motor Vehicle Record before receiving a final offer of employment.

Job Detail

When can you begin?

What is your availability?

Full Time

Part Time

Rate of Pay Desired

Last Employer Detail

What is the name and address of your current or last employer?

May we contact them?

Yes

Your Job Title

When did you start?

When did you leave?

Name and Title of your Supervisor

Supervisor's phone number

Description of work and reason for leaving

Please provide two references that are not related to you

First Reference Name

First Reference Phone Number

First Reference Name

Second Reference Phone Number

Our positions require sustained physical labor including, but not limited to: prolonged standing, kneeling, bending, etc. and repetitive lifting up to 50 lbs., etc. Are you able to perform the tasks required for the position you are applying?

Yes

All Positions Are Seasonal Jobs. When is the approximate last date you can work?

CONSENT TO BACKGROUND CHECK:

I hereby authorize Neils Lunceford, Inc. (hereafter known as “the Company”) and its agents to make investigation of my background, references, character, past employment, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. I hereby consent to the Company’s verifying all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copied of records pertaining to this information. I also hereby authorize the Company’s access to any medical histories or records pertaining to me. With regard to the foregoing disclosures, I hereby agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed.

Yes

ACKNOWLEDGEMENT OF MOTOR VEHICLES RECORD

I understand that I am required to provide a copy of my Motor Vehicle Report (MVR) at the time of an interview, if one is granted. I further understand that the information in my MVR may be used for hiring or employment purposes, and for insurance underwriting or rating purposes. Failure to provide this documentation will stop the interview process until such time as an MVR is presented.

Yes

ACKNOWLEDGEMENT SEASONAL EMPLOYEE STATUS

I understand and acknowledge that should I be offered a position with Neils Lunceford Inc. this position will be Seasonal in nature as defined by Code of Federal Regulations 29 CFR 500.20(s)(1) and employment is limited to the summer working season.

Yes

Your Signature

Signature Date