Employment

Personal
Full Name*
Home Phone*
Present Address*
Street Address City State ZIP Code
Email*
Drivers License Number*
Are you a U.S. Citizen, or do you have the legal right to be employed in the U.S.?*
- Yes
- No
Are You Over 18?*
- Yes
- No
Employment Desired*
- Full-Time
- Part-Time
- Temp or Summer Employment
Position Desired*
Salary Desired*
Date Available*
MM slash DD slash YYYY
Have you ever applied to LynCo?*
- Yes
- No
Worked for us before?*
- Yes
- No
If answer to either question is yes, state when and where you applied and/or worked.
How did you learn of LynCo and/or position?*
Are you now, or do you expect to be engaged in any other business or employment?*
- Yes
- No
Are there days or hours you are unable or unwilling to work?*
- Yes
- No
If yes, please specify days or hours.
Work History

List employers in consecutive order with present or last employer first. Account for all periods of time including military services and period of unemployment. If self employed, give firm name and supply business references.
Employer 1
Employer
Phone
Address
Supervisor
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Position
Type of Business
Ending Salary
Duties
Reason for Leaving
Employer 2
Employer
Phone
Address
Supervisor
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Position
Type of Business
Ending Salary
Duties
Reason for Leaving
Employer 3
Employer
Phone
Address
Supervisor
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Position
Type of Business
Ending Salary
Duties
Reason for Leaving
References

List three references, not relatives or former employers.
Reference 1
Name*
Address*
Phone*
Occupation*
Reference 2
Name*
Address*
Phone*
Occupation*
Reference 3
Name*
Address*
Phone*
Occupation*
Education
High School
High School Name
City & State
Graduated
- Yes
- No
Courses Studied:
College
College Name
City & State
Graduated
- Yes
- No
Courses Studied:
Trade School
Trade School Name
City & State
Graduated
- Yes
- No
Courses Studied:
If you did not graduate, why did you leave high school or college?
Do you plan to pursue further studies?*
- Yes
- No
If so, when, where and what courses?
List scholastic honors, offices held and activities involved in during high school and college:
List and describe any other School of Specialized Training:
Ever served in the military?
- Yes
- No
Service Branch
Special Skills
Do you type?*
- Yes
- No
Words per minute*
Computer knowledge or training?*
- Yes
- No
If yes, describe:
Languages spoken fluently?
Affidavit

I certify the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree the company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. I also authorize the companies, schools or persons named above to give any information regarding my employment, character and qualifications and hereby release said companies, schools or persons from all liability for any damage for issuing this information. I understand that the taking of drug tests may be a condition of employment and refusal to take such tests when asked will subject me to termination. I also understand that no person is authorized to enter into any written or verbal employment contracts on behalf of the company without the express written consent of the President.

I hereby authorize and request any current or former employer, school, police department, financial institution, credit bureau or other persons having personal knowledge about me, to furnish the Company and/or its agent with any and all information in their possession regarding me in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any current or former employer who may provide information based upon this authorized request. I understand this authorization is to part of the written employment application which I sign.

I agree during my term of employment and afterwards, not to disclose at any time, or make use of, confidential information relating to the business of LynCo, its' products, research (including projects or business ideas in which I was a party), customer lists, or similar information not generally known or available to the public, without prior written consent of the President. In the event a potential conflict of interest or doubt regarding any activity in which I am engaged, or I plan to engage in the future, I will submit the problem to the President for review. Upon leaving the employ of LynCo, I agree all records, reports, notes, compilations, other recorded or documented matter, and any copies thereof, is the exclusive property of LynCo.
Type your full name:*
Date*
MM slash DD slash YYYY
If name changed (through marriage or otherwise), please type former name in full:
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Employment

Personal

Work History

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

Education

High School

College

Trade School

Special Skills

Affidavit