Online Application for Employment

Employment Application

The Larrabee Center, Inc./Trinkets & Togs Thrift Stores

Application for Employment *

Qualified applicants are considered for employment without regard to race, religion, national origin, sex, age, marital or veteran status, or the presence of a non-job related medical condition or disability.

Check the box that you have read this statement.

Name *

First

Middle

Last

Please list maiden or other former names

Email *

Phone *

Address *

Address Line 1

City

State

Zip Code

If other

Position(s) you are applying for: *

Date Available to Start Work *

Please specify days/hours desired *

Are you available *

Full Time
Part Time
Seasonal/Temporary

Are you legally eligible for employment in the United States and able to provide verification? *

Have you ever been convicted of a crime in this state or any other state? (Background checks will be completed on all applicants that are offered employment. A conviction will not necessarily disqualify an applicant from employment. However, failure to answer the above questions truthfully will be immediate grounds for disregarding your application for employment. **The DCI maintains conviction records and deferred judgements without time limits.**) *

Do you have any record of founded child or dependent adult abuse in this state or any other state? *

Education

Education information will be used for positions where specific education and training is required.

Do you have a High School Diploma or GED? *

Name of last school attended

Address

Address Line 1

City

State

Zip Code

Please list area of concentration and/or degree, certificates, licenses, endorsements, or other training or skills

Military History

Please List Branch of Service/Final Rank/Major Responsibilities/Training

REFERENCES

Please list any other work/volunteer/military/educational references you feel would be able to give information regarding your ability to fill this position.

Reference 1 - Full Name *

Number of Years Known *

Phone *

Address

Address Line 1

City

State

Zip Code

Reference 2 - Full Name

Number of Years Known *

Phone *

Address

Address Line 1

City

State

Zip Code

Reference 3 - Full Name *

Number of Years Known *

Phone *

Address

Address Line 1

City

State

Zip Code

EMPLOYMENT RECORD

Please list your present or most recent job/military/volunteer experiences first.

Company Name *

Job Title *

Address

Address Line 1

City

State

Zip Code

Phone *

Supervisor Name *

Rate of Pay

Employment Date Started *

Employment Date Ended *

Major Duties, Strengths, and Contributions in this Position

Presently employed with this company
May we contact this employer as a reference

Reason for Leaving this Position

Company Name *

Job Title *

Address

Address Line 1

City

State

Zip Code

Phone *

Supervisor Name *

Rate of Pay

Employment Date Started *

Employment Date Ended *

Presently employed with this company
May we contact this employer as a reference

Reason for Leaving this Position

Major Duties, Strengths, and Contributions in this Position

Company Name *

Job Title *

Address

Address Line 1

City

State

Zip Code

Phone *

Supervisor Name *

Rate of Pay

Employment Date Started *

Employment Date Ended *

Presently employed with this company
May we contact this employer as a reference

Reason for Leaving this Position

Major Duties, Strengths, and Contributions in this Position

Upload your resume

Click or drag a file to this area to upload.

Upload a cover letter

Click or drag a file to this area to upload.

Please Read Carefully Before Submitting This Application

I give my permission to The Larrabee Center, Inc. to obtain job-related information concerning my prior employment history from previous employers, listed references, the Department of Criminal Investigation, the Department of Human Services, the Office of Inspector General, and the System for Award Management (SAM). I give my permission to previous employers, the listed references, the Department of Criminal Investigation, the Department of Human Services, the Office of Inspector General, and the System for Award Management to provide job-related information concerning my employment at their company, record of criminal conviction, founded child or dependent adult abuse, or exclusion from Medicaid service provision. I release all concerned from any liability in connection therewith. My signature below indicates that I have read, understood, and agreed to the preceding statement and that I have made true, correct, and complete answers and statements on this application. I understand that my answers and statements will be relied upon by TLC, Inc. in considering my application for employment, and I understand that any omission or false answer or statement made by me on this application, or any supplements to it, will be considered cause for dismissal or the withdrawal of job offer. *Type your name here in acknowledgement of the above statement* *

Phone

Employment Application

Education

Military History

REFERENCES

EMPLOYMENT RECORD

Please Read Carefully Before Submitting This Application

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