Employment

Employment Application

LMT – Mercer Group, Inc. is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status.

Applicant Information
Name*
First Middle Last
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Desired Salary*
Date Available*
MM slash DD slash YYYY
Position Applied For*
Are you authorized to work in the US?*
- Yes
- No
Have you ever worked for this company?*
- Yes
- No
When?
Do you have reliable transportation?*
- Yes
- No
Education
Did you attend High School?*
- Yes
- No
High School Name*
High School Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Did you graduate?*
- Yes
- No
Degree
Did you attend College?*
- Yes
- No
College Name*
College Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Did you graduate?*
- Yes
- No
Degree*
Did you attend any other educational program?*
- Yes
- No
Program Name*
Program Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Did you graduate?*
- Yes
- No
Degree
References
Please list 3 professional references.
Reference #1*
Full Name Relationship Email Phone
Reference #2*
Full Name Relationship Email Phone
Reference #3*
Full Name Relationship Email Phone
Previous Employment
1st Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
2nd Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
3rd Company
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Military Service
Have you done any military service?*
- Yes
- No
Branch
Starting Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Rank at Discharge
Type of Discharge
If other than Honorable, explain
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my termination of employment.*
- Yes
- No
Equal Employment Opportunity Form: Voluntary Information
This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.
Racial or Ethnic Group
- Native American / Alaskan
- Asian / Pacifistic Islander
- Black / African American
- Hispanic / Latino
- White / Caucasian
- Other
Gender
- Male
- Female
Military Service
- Pre-Vietnam Era
- Vietnam Era
- Post Vietnam Era
- Disabled Veteran
How did you learn about this position?
- Newspaper
- Company Employee
- Professional Publication
- Job Fair
- Placement Office
- Website
- Other
How did you learn about this position?
Background Search Release Information
All fields must be completed in order to process application
Prior Address(es)*
List all from past 7 years including dates
Social Security Number*
Date Of Birth*
MM slash DD slash YYYY
Drivers License #*
State*
State / Province / Region
Signature*
I voluntarily consent to and authorize TenantSafe/ApplicantSafe, herein referred to as company, and or their assigned agents, or consumer reporting agencies to request and receive any consumer reports, investigative reports, or information concerning me. Reports requested may include any of the following: Law Enforcement Records, Criminal Records, D.M.V. Records,Civil Records, Employment/Rental Verifications, Eviction Searches, Education verification and Consumer Credit Reports. I authorize any persons, companies, corporations, consumer reporting agencies, courts of law, current or past employer to furnish company and or their assigned agents, associates or consumer reporting agencies with any or all information concerning me. I further agree to release Company and or their assigned agents, associates or consumer reporting agencies and all persons and organizations providing information from any and all claims, liability and responsibility arising out of the release of such information in connection with this research. I understand that I have specific prescribed rights as a consumer under The Federal Fair Credit Reporting Act (FCRA) and may have additional rights under relevant specific state laws. This authorization does not include a release of my medical information.

Employment

Employment Application

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer and Signature

Equal Employment Opportunity Form: Voluntary Information

Background Search Release Information