It Is our policy to comply with all applicable state and federal laws prohibitng discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification.
Date
City
State
Home Phone Number
Alternate Phone Number
How did you learn of this opening?
Are you authorized to work in the U.S. on an unrestricted basis?
High School
Have you worked here before?
Are you over 18 years of age?
Have you been told the essential functions of the job or have you been shown a copy of the description listing the essential functions of the job?
Can you perform these essential funcctions with our without reasonable accomodations?
Are there any hours or days you cannot or will not work?
Position Preferred
Are you willing to work overtime?
Have you ever been convicted of a felony?
(A conviction will not necessarily disqualify an applicant for employment.)
If yes, describe conditions
EDUCATION
NAME & LOCATION OF SCHOOL
YEAR GRADUATED
MAJOR
DIPLOMA/DEGREE
Work History
POSITION APPLIED FOR
Telephone
Most Recent Employer
College/Univ.
College/Univ.
Other Training /Education
In addition to your work history, what other experiences, skills or qualifications would especially fit you for work with our company?
1.
2.
Wage or salary desired
$
When can you start?
May we contact your present employer?
Address
Start Date
Starting Salary: $
Per
Starting Position
End Date
Ending Salary: $
Per
Ending Position
Name and Title of Supervisor
Description of Duties
Reason for Leaving
Previous Employer
Address
Telephone
Start Date
Starting Salary: $
Per
Starting Position
End Date
Ending Salary: $
Per
Ending Position
Name and Title of Supervisor
Description of Duties
Reason for Leaving
Previous Employer
Address
Telephone
Start Date
Starting Salary: $
Per
Starting Position
End Date
Ending Salary: $
Per
Ending Position
Name and Title of Supervisor
Description of Duties
Reason for Leaving
Do you certify and agree with the above agreement?
Applicant's Name
Date
PERSONAL REFERENCES
1. Name
Address
Telephone Number
Business or Occupation
2. Name
Address
Telephone Number
Business or Occupation
3. Name
Address
Telephone Number
Business or Occupation
4. Name
Address
Telephone Number
Business or Occupation
I HEREBY CERTIFY THAT THIS APPLICATION CONTAINS NO WILLFUL MISREPRESENTATION OR
FALSIFICATION AND THAT THE INFORMATION GlVEN BY ME IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE AND BELIEF. YOU MAYCONTACT PREVIOUS EMPLOYERS AND REFERENCES TO VERIFY THE
INFORMATION.
Do you certify and agree with the above agreement?
Applicant's Name
Date
Upon completion of this LDCAA Employment Application please left click the Submit button below. Upon clicking this button all information will be sent to the LDCAA Personnel Department for processing and this screen will be cleared.
Zip
Are you 21 years of age or older?
Are you 25 years of age or older?
Answer the following question only if you are applying for a position with Head Start.
Answer the following question only if you are applying for a position with Transit.
Address
E-Mail
Optional information used for governmental record requirements. The following information
will not be submitted on your application but will be kept for record requirements.
Please click on your choice below.
Gender
Race/Ethnicity
LDCAA will only accept applications for current job openings
LDCAA will only accept applications for current job openings
If you would like to submit your resume, in addition to the application above,
LDCAA will only accept applications and resumes for current job openings
Your application will only be considered for the current job opening(s) for which you applied. Your application will not be considered for any other future job openings. If you wish to apply for a job opening in the future you must complete a new application for that job.
LDCAA uses E-Verify.
U.S. law requires companies to employ only individuals who may legally work in the United States – both U.S. citizens and foreign visitors who are permitted to work. E-Verify is an Internet-based system that allows businesses to determine the eligibility of their employees to work in the United States.
The agency offers no employment contracts nor does it guarantee any minimum length of employment. The agency reserves the right to terminate any employee at any time "at-will," with or without cause, and for any reason not prohibited by statute. A supervisor or program director of the agency has no authority whatsoever to make any contrary representations to any employee.
A background check may be required.
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, age, disability, religion, sex, and familial status. (not all prohibited bases apply to programs). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W. Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202)720-6382 (TDD).
APPLICANT'S CERTIFICATION AND AGREEMENT: I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that If I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application. I understand that employment at this Company is "at-will", which means that either I or the Company can terminate the employment relationship at any time, and with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Company, other than the president has any authority to alter the foregoing.
