Norterra Employment Application

It is the policy of Luv 2 Play to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Information

Location of Employment:*

Full Name:*

First

Last

Home Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Years at this address:*

Daytime Phone:

Area Code

-

Phone Number

Evening Phone:

Area Code

-

Phone Number

Mobile Phone:*

Area Code

-

Phone Number

E-mail:*

Driver's License (State/Number):*

Emergency Information

Who should be contacted if you are involved in an emergency?

Contact Name:*

First

Last

Relationship to you:*

Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Phone:*

Area Code

-

Phone Number

General Information

Job Position Appliying For:*

Full or Part Time?*

Who referred you to our company?*

Do you have any friends or relatives who work here? If yes, please list here:

Have you applied to our company previously?*

Yes

No

If yes, when?

How will you get to work?*

Are you willing to work any shift, including nights and weekends?*

Yes

No

If no, please state any limitations:

If applicable, are you able to work overtime?*

Yes

No

If you are offered employment, when would you be available to begin work?*

If hired, are you able to submit proof that you are legally eligible for employment in the United States?*

Yes

No

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?*

Yes

No

What reasonable accommodation, if any, would you request?

Have you ever been convicted of a felony or misdemeanor?*

Yes

No

If yes, please list the crime commited, the date it was commited, and the city and state it was commited in.

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN
AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF
EMPLOYMENT.

Applicant Skills

Indicate the skills that you have. List any other skills that may be useful for the job you are seeking. Check the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Other Skills:

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.

Employer Name:

Employer Address:

Street Address City State / Province / Region Postal / Zip Code Country

Job Duties:

Reason for Leaving:

Start Date:

End Date:

Second to last Employer Name:

Second to last Employer Address:

Street Address City State / Province / Region Postal / Zip Code Country

Second to last Employer Job Duties:

Second to last Employer Reason for Leaving:

Second to last Employer Start Date:

Second to last employer End Date:

Third to last Employer Name:

Third to last Employer Address:

Street Address City State / Province / Region Postal / Zip Code Country

Third to last Employer Job Duties:

Third to last Employer Reason for Leaving:

Third to last Employer Start Date:

Third to last Employer End Date:

Applicant Education and Training

College/University Name and Address:

Did you receive a degree?

Yes

No

If yes, degree(s) received:

High School/GED Name and Address:

Did you receive a diploma?

Yes

No

Other Training:

Please indicate any current professional licenses or certifications that you hold:

Awards, Honors, Special Achievements:

Military Service:

Yes

No

Branch:

Specialized Training:

References

List any two non-relatives who would be willing to provide a reference for you.

Reference One Name:*

First

Last

Reference One Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Reference One Phone:*

Area Code

-

Phone Number

Reference One Relationship:*

Reference Two Name:*

First

Last

Reference Two Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Reference Two Phone:*

Area Code

-

Phone Number

Reference Two Relationship:*

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Luv 2 Play to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND
AND AGREE TO ITS TERMS.

By typing your name in the field below, you will be providing the signature for this document.

Applicant Signature:*

First

Last

Date:*

Word Verification: