Name:

Address:

City:

Zip Code:

Date:

Phone Number:

State:

High School

Name and City

Course of Study

Did you Graduate?

YesNo

Degree Received

College

Name & City

Course of Study

Did you graduate?

YesNo

Degree Received

Graduate School

Name & City

Course of Study

Did you Graduate

YesNo

Degree Received

Other:

Name & City

Course of Study

Did you Graduate

YesNo

Degree Received

Please give your work history for the past 10 years. Note any gaps in employment. Begin with the most recent employer.

#1 - Company Name:
City:
State: ---AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
Phone Number:
Position Held:
Dates of Employment:
Reason for Separation:
Supervisor's Name:
May we Contact:
YesNo

#2 - Company Name:
City:
State: ---AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
Phone Number:
Position Held:
Dates of Employment:
Reason for Separation:
Supervisor's Name:
May we Contact:
YesNo

#3 - Company Name:
City:
State: ---AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
Phone Number:
Position Held:
Dates of Employment:
Reason for Separation:
Supervisor's Name:
May we Contact:
YesNo

Time Period:

Reason for Being Unemployed:

Time Period:

Reason for Being Unemployed:

Time Period:

Reason for Being Unemployed:

List any special achievements or qualifications we should be aware of:

---

In completing this application I verify that everything is true and accurate. Should I be granted a personal interview, I agree that information will be true as well. I understand that any false statements can lead to immediate termination or failure to hire. I understand that this application will only be considered for 30 days from the date I signed the document. Should I want to be considered after this time, I will need to re-apply.

A.L.P. Lighting has the right to verify any of this information with any former employer, motor vehicle department, criminal history, personal reference or educational institution. A.L.P. Lighting has the right to use outside agencies as it deems necessary to verify this information and/or during the course of an investigation at any time prior to or during my employment.

Should I be offered a job, I agree to comply with all policies including drug testing of A.L.P. LIGHTING. I understand only management has the authority to make or change policies. All employment at A.L.P. is at will.

Drug Screen & Background Check Required

Applicant Signature
Enter Today's Date

A.L.P. is an equal opportunity Employer

---

A.L.P. Lighting is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, A.L.P. Lighting invites applicants to voluntarily self-identify their race/ethnicity and gender. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement.