Employment Application

An equal opportunity employer

Personal Information
Last Name *
First Name *
Middle Initial *
Date *
Date format must be mm/dd/yyyy
Other names by which you have been known
Date of Birth *
Date format must be mm/dd/yyyy
Social Security Number *
Home Phone *
Business Phone
Invalid Input
Email Address *
Street Address *
City *
State *
Zip Code *
Previous Address (if at current address less than 5 years)
Driver’s License Number/State
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Emergency Contact
Address
Phone Number
Are you 18 years or older? *
Are you either a U.S. Citizen or an alien authorized to work in the U.S.? *
Have you ever been convicted of a felony? *
If yes, give date, place, offense, and explain:
How were you referred to LeeShanok Network Solutions?
Have you ever been employed or contracted by LeeShanok in the past? (Please check Yes or No and Full-Time or Part-Time) *
If Yes, what position did you hold and when?
Resume
Upload Your Resume (accepted formats .tif, .doc, .docx, .xls, .xlsx, .jpg, .png, pdf) *
Please upload a resume in an acceptable format and under 4mb.
Cover Letter
Upload a cover letter: *
Please upload a cover letter in an acceptable format and under 4mb.
Additional Cover Letter
Additional letter of recommendation:
Additional Cover Letter
Additional letter of recommendation:
Additional Cover Letter
Additional letter of recommendation:
Additional Cover Letter
Additional letter of recommendation:
Desired Employment
Position *
Salary Desired *
Date Available *
Are you employed now? *
If so, may we inquire of your present employer? *
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Education
High School
Name and Location of School
No. of Years Attended
Major
Degree
College/University
Name and Location of School
No. of Years Attended
Major
Degree
Technical/Trade
Name and Location of School
No. of Years Attended
Major
Degree
Additional Education/Certification
Work History
Company Name*
Street Address*
City*
State*
Zip Code*
May we contact employer?*
Starting Job Title*
Final Job Title*
Starting Date*
Date format must be mm/dd/yyyy
Leaving Date*
Date format must be mm/dd/yyyy
Starting Rate of Pay*
Ending Rate of Pay*
Supervisor’s Name and Title*
Phone Number*
Description of Job Duties*
Reason for Leaving or Reason Why You’re Considering Leaving*
Work History
Company Name
Street Address
City
State
Zip Code
May we contact employer?
Starting Job Title
Final Job Title
Starting Date
Leaving Date
Starting Rate of Pay
Ending Rate of Pay
Supervisor’s Name and Title
Phone Number
Description of Job Duties
Reason for Leaving or Reason Why You’re Considering Leaving
Work History
Company Name
Street Address
City
State
Zip Code
May we contact employer?
Starting Job Title
Final Job Title
Starting Date
Leaving Date
Starting Rate of Pay
Ending Rate of Pay
Supervisor’s Name and Title
Phone Number
Description of Job Duties
Reason for Leaving or Reason Why You’re Considering Leaving
Business References
Name *
Company *
Address *
Phone Number *
Business Relationship
Invalid Input
How Many Years? *
Business References
Name *
Company *
Address *
Phone Number *
Business Relationship
Invalid Input
How Many Years? *
Business References
Name *
Company *
Address *
Phone Number *
Business Relationship
Invalid Input
How Many Years? *
Do you have any physical limitations that preclude you from performing any work for which you are being considered? *
{If Yes, describe the injuries.
If Yes, what can be done to accommodate your limitations?
Were you ever seriously injured? *
What foreign languages do you speak fluently?


Read Carefully and Sign

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal. I authorized verification of information provided on this application and authorize the references listed above to give you all pertinent information concerning my previous employment and release all parties from all liability for any damage that may result from furnishing information to LeeShanok Network Solutions. In consideration of my employment, I agree to conform to the rules and regulations of LeeShanok Network Solutions. I understand and agree that I may be requested to take one or more physical examination, lie detector, and substance test as a condition of hiring or continued employment. I agree to consent to such test(s) at such time as designed by the Company and to release the Company, its directors, officers, agents or employees from any claim arising in connect with such test(s). I further agree that either I or the Company may terminate my employment with or without cause and with or without notice, at any time. Finally, I understand that no representative of the Company other than an Executive Offer has the authority to enter into any agreement for employment for any specified period or time, or to otherwise after the foregoing.

By typing your name below you agree with the statement above. Please type your name below with today's date.

Full Name *
Date *
Date format must be mm/dd/yyyy


Disclosure and Authorization for Background Investigation


I understand that in connection with my application for employment (including contracts for service), LeeShanok Network Solutions will use an outside agency to research and verify information I have provided. I hereby authorize LeeShanok Network Solutions and/or other entity directed by LeeShanok Network Solutions prior to or at any time after my employment commences to obtain a consumer report for employment purposes. I understand this consumer report may include inquiries regarding my work history; court records, including criminal convictions record, as permitted by law; driving history; verification of Social Security Number; and references obtained from professional and personal associates.

I hereby authorize all previous employers, educational institutions, consumer reporting agencies, and other persons or entities having information about me to provide such information to LeeShanok Network Solutions or other entities that obtains information for LeeShanok Network Solutions. I further release LeeShanok Network Solutions, its employees, officers, agents, successors and assigns, and all other parties involved in the investigation, from any claim or action for any liability whatsoever related to the process or results of the background/reference investigation.

I understand results of my background check may be used in determining whether to make me an offer of employment and other employment decisions, and that the Disclosure Authorization is not an offer for employment by LeeShanok Network Solutions or a contract with LeeShanok Network Solutions. I further understand that no representative of LeeShanok Network Solutions other than an Executive Officer has the authority to enter into any agreement for employment for any specified period of time, or to otherwise alter LeeShanok Network Solutions’ At-Will Employment Policy.


By typing your name below you agree with the statement above. Please type your name below with today's date.

Full Name *
Date *
Date format must be mm/dd/yyyy
Security Question
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