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An Equal Opportunity Employer

It is the policy of L&S Transportation LLC to provide employment opportunities without regard to race, color, religion, sex, national origin, age, handicap, or veteran status.

Application For Employment
Answers that are incomplete may prevent us from considering your application.

Personal Data

Name:
First	Middle	Last	SSN - -

Present Address:			Permanent Address: (If different from present address)
Street			Street
City			City
State		Zip Code	State		Zip Code
Phone	- -		Phone	- -
E-mail

Are you a citizen of the United States?	yes	no
If not, please explain your working status

Position Information

Position Desired
Referral Source
Please specify

Are you willing to work any shift, including nights and weekends?			yes	no
How soon following notification can you report?
Are you willing to relocate?			yes	no
Have you ever been employed by the company?			yes	no
If so, when?	/ to /
Where		Postion
Are any relatives, including in-laws, employed by the company?			yes	no
If yes, please provide their:
Name		Relation
Position		Location
Have you ever previously applied for employment at the company?			yes	no
If so, when?	/
Have you ever previoiusly been interviewed by the company?			yes	no
If so, when?	/	For what position?

Education

High School		Attendance Dates	/ to /
Street		Graduated	yes	no
City
State	Zip Code

College/University		Attendance Dates	/ to /
Street		Graduated	yes	no
City		Degree
State	Zip Code	Major

College/University		Attendance Dates	/ to /
Street		Graduated	yes	no
City		Degree
State	Zip Code	Major

Trade/Business School		Attendance Dates	/ to /
Street		Graduated	yes	no
City		Degree
State	Zip Code	Major

Employment History
Important! Starting with your present or most recent employer, list in consecutive order your last four employers.

Present or Most Recent Employer
Name of Company:		Salary:	Begin		End
Street:		Emp Dates:	From	/	To	/
City:		Supervisor:	Name
State	Zip Code		Title
Your Title:		Reason for Leaving:
Duties:

Previous Employer
Name of Company:		Salary:	Begin		End
Street:		Emp Dates:	From	/	To	/
City:		Supervisor:	Name
State	Zip Code		Title
Your Title:		Reason for Leaving:
Duties:

Previous Employer
Name of Company:		Salary:	Begin		End
Street:		Emp Dates:	From	/	To	/
City:		Supervisor:	Name
State	Zip Code		Title
Your Title:		Reason for Leaving:
Duties:

Previous Employer
Name of Company:		Salary:	Begin		End
Street:		Emp Dates:	From	/	To	/
City:		Supervisor:	Name
State	Zip Code		Title
Your Title:		Reason for Leaving:
Duties:

Other Employment
List part-time employment while in school, including company name(s), addresses, dates of employment:

Are there any periods of unemployment and/or part-time employment since you graduated or last attended high school which are not listed above?	yes	no
If yes, please explain:
Have you ever been suspended, placed on probation, asked to resign, discharged or terminated?	yes	no
If yes, please explain:

Miscellaneous Information

Do you have a valid driver's license?		yes	no
License Number	State	Expiration date / /
Have you ever been convicted of or sentenced for any violation of the law?		yes	no
If yes, give full particulars. (The existence of a criminal record does not constitute an automatic bar to employment)

Military Service and Status
Branch of Service			Military Occupation
Length of Active Duty	Entry	/	Separation	/
Rank at Time of Separation:
Please note: Final processing prior to employment will require a review of the original or a copy of your military discharge and/or a review of you DD form 214.

References
Please list five local personal references who can vouch for you integrity.

Name

Phone

Address

- -	Street
	City
	State	Zip Code

- -	Street
	City
	State	Zip Code

- -	Street
	City
	State	Zip Code

- -	Street
	City
	State	Zip Code

- -	Street
	City
	State	Zip Code

Applicant's Certification and Agreement

I hereby certify that my answers to the foregoing questions are true and complete and that I have not knowingly withheld any facts, circumstances or other information which would, if disclosed, affect my application. I further understand that any false of misleading statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discovered subsequent to my employment.

I hereby affirm that by execution of the application, I acknowledge that the Company has disclosed to me that an Investigative Consumer Report, including information as to my character, general reputation, personal characteristics, and mode of living may be made; and that I, upon written request to the Company made within a reasonable time after the date of this application, may obtain a complete and accurate disclosure of the nature and scope of the investigation requested.

I hereby authorize the Company to request, and I also authorize and request each former employer, school attended, and each person, firm, or corporation given as references above, to furnish at any time, any information which may be sought concerning me and my work habits, character or skill, and any other data required, whether in connection with this application or for purposes of complying with surety company requirements or otherwise.

I hereby affirm that by submitting this application I agree to submit to medical evaluation and/or examinations, including tests for the presence of illegal drugs or alcohol, prior to and during employment, within a time period prescribed by the Company and as often as directed during employment.

I hereby authorize the medical examiner to disclose to the Company any and all findings and conclusions arrived at in any examination performed either prior to employment or during employment.

I understand that should I be given employment, such employment shall be for an undefinite period of time and may be terminated, at will, at anytime, for any reason, by me or by the Company without notice or without liability whatsoever, except for unpaid wages or salary earned by the date of termination. I further understand that only the Executive Vice President of the Company has the authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to this at will standard and that any such agreement must be in writing.

I understand that if I am employed, the terms and conditions of my employment will be governed by this application and the Company's Terms of Employment and Policy and Procedures, as amended from time to time by the Company.

The Company operates under the principles of affording equal employment opportunity through affirmative action for qualified handicapped individuals, qualified veterans of the VIetnam era and qualified disabled veterans.

All applicants and employees who believe themselves to be members of one or more of these groups, and who wish to identify themselves as such for the purpose of affirmative action consideration are invited to do so.

Submission of this information is voluntary and refusal to provide it will not subject you to discharge or disciplinary treatment. Information obtained concerning individuals shall be kept confidential, except that (1) supervisors and managers may be informed regarding disabled veterans and handicapped individuals, as necessary, (2) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment, and (3) government officials investigating compliance will be informed.

I wish to volunteer the following information:	I do not qualify
I do qualify under the following :	Handicapped
	Vietnam Era Veteran
	Disabled Veteran

Submission of this form certifies agreement to the terms stated above

Employee Access Please Please press HERE