Employment

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability or national origin.

Current Open Positions:

Administrative Assistant
Sales Representative

Employment Application

Step 1 of 6

Today's Date*
Date Format: MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Are you 18 or Older?*
- Yes
- No
Are you Lawfully able to work in this country?*
- Yes
- No
Are you able to drive for work?*
- Yes
- No
Referred by

EDUCATION

List*

School Level	Name and Location	Number of Years Attended	Did You Graduate?	Subjects Studied

Enter information in each column. Click the plus arrow to add a new entry row up to 3 rows.

Special Course or Training
Experience/Skills related to the Position for which you are applying.

US Military Service

Brance of Service	Rank	Present Member of National Guard or Reserves? (Yes or No)

EMPLOYMENT HISTORY

Please list your last 3 employers, within the past 5 years, start with the last employer first.*

Dates Worked (D/M/Y - D/M/Y)	Name of Employer	Position	Supervisor name and phone number	Starting Salary	Ending Salary	Reason for Leaving

Hit the plus icon to add a new entry row. Please fill out 3 past employers.

Please provide any additional information that may be helpful in considering yoru application.
REFERENCES

Please give the names of 3 people not related to you and not former employers whom you have known for at least 1 year.

Name	Address and Phone Number	Business	Years Known

EMERGENCY CONTACT
Preferred contact in case of emergency.
Name Relationship Phone Number

ACKNOWLEDGEMENT
Please read the following before clicking "I agree" below. Lutgen Companies is an Equal Opportunity Employer.
1. I acknowledge and certify that the information contained in this application is true and accurate to the best of my knowledge.
2. I give Lutgen Companies full authorization on to verify any information contained in this application and authorize the Company to make any necessary inquiries regarding my character, reputation and abilities.
3. I fully release any individuals providing information to the Company regarding my character, reputation and abilities from and all liability regarding this information.
4. I acknowledge and understand that if any false information, inaccuracies, omissions, misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated based upon this discovery at any time.
5. I acknowledge and agree that if I am employed I will be expected to conform with any and all company rules, regulations, policies, and procedures, written or unwritten.
6. I acknowledge and agree that if I am hired, I will be considered an "at-will" employee and that my employment may be terminated at any time, with or without cause, with or without notice, by myself or by the company.
7. I acknowledge and understand that as a condition of employment I may be required to undertake a drug and alcohol test and/or a physical examination to determine if I am able to complete the essential functions of the job with or without accommodations.
8. I acknowledge and understand that this is an application for employment and not an offer or guarantee of employment.
9. I acknowledge and understand that any offer of employment will be based upon my ability to perform the essential functions of the job with or without reasonable accommodation, including and but not limited to: technical abilities, lifting requirements, driving ability, attendance expectations and attitude & behavior expectations.
Digital Signature*
I agree to the above and certify that all the information I have provided is correct.
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Current Open Positions:

Employment Application

Step 1 of 6

EMPLOYMENT DESIRED

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

EMERGENCY CONTACT

PHYSICAL REQUIREMENTS

ACKNOWLEDGEMENT

Professional

Quality

2015 | 2016 | 2018

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