Employment Application

PLEASE ANSWER ALL QUESTIONS

Leadership Training Institute (LTI) fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law.

In accordance with requirements of the Americans with Disabilities Act and applicable state laws, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a full and fair opportunity to be considered for employment.

As an Equal Opportunity Employer, we intend to comply fully with applicable federal and state employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, LTI maintains a smoke-free workplace.

Position Applying for:

Date:

PERSONAL DATA

First Name:

Middle Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone (Home):

Cell:

Email:

If you are under 18 years of age, please specify your age:

This information will be used only for child labor law purposes.

Can you travel if the job requires it?

Yes

When will you be available to start work?

What days and time(s) are you available to work?

Are you interested in:

Full Time

Part Time

Temporary

Have you ever been convicted of a crime including any sexual or child abuse/neglect related offense?

Yes

Note: Answering “yes” does not automatically exclude you from further consideration

Please explain:

Do you have a valid driver’s license?

Yes

State:

License Number:

How did you learn about LTI?

If referral, who were you referred by?

Have you ever applied or worked for LTI before?

Yes

Provide Dates:

Are you legally authorized to work in the United States?

Yes

Will you now or in the future require sponsorship for employment visa status (e.g.,H-1B visa status)?

Yes

Note: The Federal Immigration Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

EDUCATION - Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

Levels of Education Completed (Select all that apply):

GED

High School

College or University

Technical/specialized training/certification

List Name(s) of High School(s) and years attended:

Did you graduate?

Yes

What was your Overall Grade Point Average?

List College(s)/University and years attended followed by Type of Degree Received or Expected, Major and Minor, as well as Overall Grade Point Average for each at time of this application:

List Technical/specialized training school/program and years attended followed by Type of Certification Received or Expected:

LANGUAGES

Do you speak/read/write in any languages other than English?

Yes

Please enter other language(s) you speak and indicate for each language the level of your ability (fluent, good or fair):

Please enter other language(s) you read and indicate for each language the level of your ability (fluent, good or fair):

Please enter other language(s) you write and indicate for each language the level of your ability (fluent, good or fair):

EMPLOYMENT HISTORY:

Please complete for all full-time or part-time employment beginning with most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include active military assignments and voluntary employment and provide ten (10) years of history You must explain any gaps in your employment history. You can upload additional employment information and/or a resume below.

Employer Name:

Telephone:

Address:

Name of Supervisor:

May we contact Supervisor:

Yes

Start Date:

End Date:

Your Role:

Paid Employee

Volunteer

Other…

State job titles and describe job duties:

Reason for Leaving:

Employer Name:

Telephone:

Address:

Name of Supervisor:

May we contact Supervisor:

Yes

Start Date:

End Date:

Your Role:

Paid Employee

Volunteer

Other…

Duties:

Reason for Leaving:

Employer Name:

Telephone:

Address:

Name of Supervisor:

May we contact Supervisor:

Yes

Start Date:

End Date:

Your Role:

Paid Employee

Volunteer

Other…

State job titles and describe job duties:

Reason for Leaving:

Have you ever been discharged or forced to resign?

Yes

Explain:

Were you given a performance evaluation within the last 12 months of active employment?

Yes

What was the range of scores used and what was your score?

Upload Additional Employment History and/or Resume

Maximum 2 files.
200 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Are you serving or have you served in the Military?

Yes

MILITARY

Branch of Service:

Number of Years /Months of Service:

Rank at Discharge:

Date of Discharge:

Describe any military skills, training or experience you believe are relevant to the job you applied for:

EMERGENCY CONTACT INFORMATION

Emergency Contact 1 Name:

Telephone:

Relationship:

Emergency Contact 2 Name:

Telephone:

Relationship:

APPLICANT’S ACKNOWLEDGMENT

I certify that the answers given herein (Supplement if applicable) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation or take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results and of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document.

Signature:

Sign above

Date: