Step 1: Applicant Information

Do you want to work: Full-Time
If Part-Time, what days/hours?
Are 18 years of age or older? Yes
Are you authorized to work in the U.S? Yes
Have you ever worked for us before? Yes
If yes, when?
Have you ever applied for work with us before? Yes
If yes, when?
Are you able to perform the essential functions of the job for which you are applying, as indicated in the job posting, with or without accommodation? Yes
If not, please explain
Have you ever been convicted of a crime? Yes
If yes, explain
Have you ever been arrested for a felony? Yes
If yes, explain
Do you have any skills, qualifications, or experiences you feel would help you perform the job for which you are applying?
Have you ever been fired? Yes
If yes, why?
List anyone you know who works for us
If someone referred you to us, please tell us who
How did you learn about this job opening?

Step 2: Education




Step 3: References

Please list 3 professional references

Reference #1

Reference #2

Reference #3

Step 4: Previous Employment

Previous Job #1

Previous Job #2

Previous Job #3

Previous Job #4

Step 5: Military Experience

Keep fields blank if not applicable

Step 6: Applicant Certification and Authorization

1. Certification of Truthfulness.

I certify that all information I have provided in this application is true to the best of my knowledge, and I have not knowingly withheld any information requested. I agree that this information may be investigated. I understand that withholding information or providing false or misleading information on this application is grounds for rejection of my application or, if employed, discharge.

2. Authorization for Employment/Educational Information.

I authorize the references listed in this application, and any prior employer, educational institution, or any other persons or organizations, to give Lakeshore Glass & Metals, LLC all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to Lakeshore Glass & Metals, LLC. I hereby waive written notice that employment information is being provided by any person or organization.

3. Employment at Will.

If I am hired, in consideration of my employment, I agree to abide by the rules and policies of Lakeshore Glass & Metals, LLC, including any changes made from time to time, and agree that my employment and compensation is at-will and can be terminated with or without cause, and with or without notice, at any time, at the option of either Lakeshore Glass & Metals, LLC or myself. I understand that no manager or other representative of Lakeshore Glass & Metals, LLC, other than the Owner, has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the Owner must be made in writing to be effective.

4. Authorization to Work.

If I am selected for hire, I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986.

5. Need for Accommodation.

If I have a mental or physical disability and require an accommodation to perform the job, I must notify Lakeshore Glass & Metals, LLC in writing of that need within 182 days after I knew or reasonably should have known that an accommodation was needed. Failure to do so will bar me from alleging that Lakeshore Glass & Metals, LLC has not accommodated me as required by law.

6. Criminal Records Check.

I authorize Lakeshore Glass & Metals, LLC to secure my criminal conviction history. I agree to execute the appropriate authorization if necessary to obtain such information.

7. Driving Record Check.

I agree to execute an authorization for this employer to inquire into, and obtain documents related to, any driving record from every state in which I have held a motor vehicle operator's license or permit.

8. Release of Medical Information.

I authorize every medical doctor, physician or other health care provider to provide any and all information, including but not limited to, all medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I hereby release every medical doctor, health care personnel, and every other person, firm, officer, corporation, association, organization or institution which shall comply with the authorization or request made in this respect from all liability. I understand that this release will not be sent to my physician or other health care provider until a conditional job offer has been made.

9. Physical Exam and Drug and Alcohol Testing.

I agree to take a physical exam following a conditional job offer. I also authorize Lakeshore Glass & Metals, LLC, or its designated agent(s), to withdraw specimen(s) of my blood, urine, hair and/or other substances for chemical analysis. One purpose of this analysis is to determine or exclude the presence of alcohol, drugs or other substances. I understand that decisions concerning my employment may be made as a result of these tests.

10. Consideration for Employment.

I understand that my application will be considered pursuant to Lakeshore Glass & Metals, LLC’s normal procedures for a period of thirty (30) days. If I am still interested in employment thereafter, I must reapply.

I agree that if any of the above commitments is ever found to be legally unenforceable as written, the commitment concerned shall be limited to allow its enforcement as far as legally possible.

I have read, understand, and agree to items 1 through 10 above. I knowingly and voluntarily acknowledge that with my signature below.