Application for Employment


Thank you for applying at Lover's Lane. This form was designed for various types of positions. Some questions may not apply to your situation, but please fill it out to the best of your ability. This application must be completed by the person applying for employment. Please print all responses. Also, please advise us if any accommodations are required to assist you in the application process. This application will remain valid for three months, after which you will need to reapply.
Lover's Lane is an Equal Opportunity Employer. All candidates will be evaluated on the basis on their qualifications for the job in question. Federal, state and/or local law prohibit discrimination on the basis of race, color, religion, sex, national origin, age, disability, or any other protected status. Federal law, however, prohibits the employment of any person who does not have the legal right to work in the United States.

Please note: You may complete the form online, then print and fax it toll-free to (877)-915-5683, or you may submit the application electronically.

Introduction

*Full Name:  *Address:
*City:   *State:   *Zip Code:
*Home Phone:   *Cell Phone:   *Work Phone:
*Email:
    Can we call you at work?   Yes   No

Work

Position Applied For:

Location(s) applied for:

Greater Detroit Area

Ann Arbor/Ypsi Clinton Township Flint
Novi Plymouth (Corporate Office) Pontiac
Redford Royal Oak Saginaw
Southgate Sterling Heights Westland

Chicagoland Area
Arlington Heights Carol Stream Downer's Grove
Hanover Park Lake Zurich Libertyville
Lombard Merrillville/Hobart North Aurora
Naperville Norridge Oak Lawn
Orland Park Schererville Shorewood
Skokie West Dundee    
           
Date you can start:
Date of Application:
How did you hear about us? Advertisement   Employment Agency   Friend
Relative   Walk-In   Other
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
You are Applying for: Full-Time Part-Time   Total hours available per week?
Wage Desired:   Check if your hours are flexible. (Available for work any day - a.m. or p.m.)
If you are applying for a position involving evening or weekend work, can you fulfill such scheduling requirements?
Yes   No   Not Applicable
Hours available:   Mon Tue Wed Thu Fri Sat Sun
please list the hours you are available to work per day. From
To
Are you willing to work overtime as requested?   Yes   No
1. Have you ever applied to this company before?  Yes  No
Where  Date
2. Have you ever been employed with this company?  Yes  No 
Location  Date
Under What Name?  Supervisor's Name:
3. Do you have relatives who are employed with this company?  Yes  No 
Name  Location
4. Are you currently employed?  Yes  No
If yes, are you seeking a second job   Or new employment 
5. Are you currently on "lay-off" status and subject to recall?  Yes  No  If yes, name of employer
  Explain:
6. Have you ever been bonded?  Yes  No  Have you ever been refused a bond? Yes  No
  Explain:
7. If employment is offered, can you submit a birth certificate, social security card, certificate of U.S citizenship, or other verification documents as permitted by Federal Law of your legal right to work in the U.S?  Yes  No 
  If employment is offered, can you produce personal identification documents such as a driver's license, U.S. passport, photographic identification card issued by the state, or other identification documents as permitted by Federal law?
Yes  No 
8. Have you ever served in the U.S. armed forces?  Yes  No
Dates Served:  Describe any special job-related training received:
9. If the job requires travel, do you have a valid driver's license?  Yes  No
License #:  Type: Number of tickets or points in last three years:
Year & Model of Auto:  Plate #:
10. Have you ever been convicted, sentenced, placed on probation, pleaded guilty or "no contest" or agreed to a deferred adjudication involving a felony or any criminal offense relating to illegal drugs, theft, fraud or violence (e.g. assault, battery, etc.)?  Yes  No
  Provide a brief explanation of those matters in which you answered "yes", including the nature of the offense, the relevant dates and current status, except that a "yes" response is not required for any matter which has been sealed, expunged, statutorily eradicated or otherwise cleared from your record. A conviction record will not necessarily bar you from employment and will be considered as it relates to the job in question.