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L.J. Star (the “Company”) is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, national origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.
Personal Information
Name
First
Middle
Last
Other name used
Address
Street Address
Address Line 2
City
State / Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Home/Cell Phone #
Business or Message #
Referred By
Salary Desired
Have you ever interviewed with the company or its affiliates before?
Yes
No
Please list date(s), job title(s) & location(s)
Have you ever been employed by the Company or its affiliates before?
Yes
No
Please list date(s), job title(s) & location(s)
Do you have any relatives employed by the Company or its affiliates?
Yes
No
Please list name(s) & location(s)
Are you at least 18 years old?
Yes
No
Educational Background
Select Highest Grade Completed:
High School
9
10
11
12
College, Trade or Business 1
2
3
4
Graduate Studies
Highschool
Address
Major Studies
Degree, Diploma, License or Certificate
College/University
Address
Major Studies
Degree, Diploma, License or Certificate
Vocational, Business, Other
Address
Major Studies
Degree, Diploma, License or Certificate
List Any Professional Designations
Other Special Knowledge, Skills or Qualifications
(For Clerical Applicants Only) Do You Type?
Yes
No
WPM
Employment History
Starting with the most recent position
, list all employment for the past 10 years. All information must be completed. You may attach a resume, but not in place of completing the required information.
Employment Date (From & To)
Employer Name
Employer Address
Salary (Starting & Ending)
Supervisor Name
Supervisor Phone #
Job Title
Reason for Leaving
Duties & Responsibilities
Employment Date (From & To)
Employer Name
Employer Address
Salary (Starting & Ending)
Supervisor Name
Supervisor Phone #
Job Title
Reason for Leaving
Duties & Responsibilities
Employment Date (From & To)
Employer Name
Employer Address
Salary (Starting & Ending)
Supervisor Name
Supervisor Phone #
Job Title
Reason for Leaving
Duties & Responsibilities
Confirmation
May we contact your current employer for references?
Yes
No
If hired, will you be able to work overtime?
Yes
No
Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodations?
Yes
No
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by court? (A yes response does not automatically disqualify your application)
Yes
No
The above information is true and correct to the best of my knowledge, I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give my information herein requested, regardless of the time elapsed after discovery.
I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.
I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.
If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The documents(s) provided will be used for completion of Form I-9.
All offers of employment are conditional upon receipt of a negative unadulterated drug screen result.
I hereby acknowledge that I have read and agree to the above statements.
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