Application for Employment

Lake Michigan Mailers, Inc. is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by applicable state or federal law. For persons employed in Michigan, state law requires that a person with a disability or handicap requiring accommodation to perform the essential duties of the job must notify the employer in writing within 182 days of the date that the need is known or should have been known.

Location Preference: (Select One): Kalamazoo, MI South Bend, IN Either

Last Name: 

First Name:

Middle Name:

Soc. Sec. #: --
Drivers License #:
 

State of Issue:

Contact Information

Street: 
       

City:
    

State:      

Zip:

Home Phone Number (123-456-7890) :
       

Work Phone Number(123-456-7890) :

Email Address:

Date You Can Start (MM/DD/YYYY):

Are you 18 years or older?
Yes No

Are there any hours or days of the week you cannot work?
Yes No

If so, when?

Do you expect your availability to change in the next 12 months?  
Yes No

Wage Desired:

Type of Employment:
Full-time Part-time
Are you presently employed?
Yes No

May we contact your present employer?
Yes No

Name, title and phone of current employer:

Have you ever applied to LMM before?
Yes No    

Date (MM/DD/YYYY):

Have you ever worked for LMM before?
Yes No     

Last Year of Employment (MM/DD/YYYY):

Education

High School Attended:

Did you graduate?
Yes No 

College Attended:

Degree?
Yes No 

Are you lawfully entitled to be employed in the United States?
Yes No 

Have you ever been convicted of a crime except a minor traffic violation?
Yes No 

If so, please state the citation, date and place where offense occurred:
Please provide any additional information such as special skills, training, experience, or qualifications you feel will be helpful to us in considering your application.

EMERGENCY CONTACT

Name:

Street:
 

City:
    

State:

Telephone Number (123-456-7890) :

References

*Three references required

Name:
Phone (123-456-7890) :

Name:  
Phone (123-456-7890) :

Name:  
Phone (123-456-7890) :

CURRENT & FORMER EMPLOYERS
(MOST RECENT ONES FIRST)

Employer:  

From (MM/YYYY):

To (MM/YYYY):

Location or Address:

Position(s) held:

Last pay rate:

Supervisor’s Name:

Phone (123-456-7890) :

Reason for leaving:

Employer:  

From (MM/YYYY):

To (MM/YYYY):

Location or Address:

Position(s) held:

Last pay rate:

Supervisor’s Name:

Phone (123-456-7890) :

Reason for leaving:

Employer:  

From (MM/YYYY):

To (MM/YYYY):

Location or Address:

Position(s) held:

Last pay rate:

Supervisor’s Name:

Phone (123-456-7890) :

Reason for leaving:

Employer:  

From (MM/YYYY):

To (MM/YYYY):

Location or Address:

Position(s) held:

Last pay rate:

Supervisor’s Name:

Phone (123-456-7890) :

Reason for leaving:

Have you ever been discharged for misconduct, theft or dishonesty?
Yes No 

If so, which employer?

May we contact the employers listed?
Yes No 

If not, which one(s)?

Are any of your relatives currently employed by Lake Michigan Mailers?  
Yes No 

If so, please list the name(s) below: