Welcome to Life Changing Support Services, Inc.

Life Changing Support Services, Inc.

Employment Application

325 Industrial Park Road
Ebensburg, PA 15931
Phone:  (814) 495-9550
Fax: (814) 240-5324

Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability, sexual orientation or any other legally protected status.

Name and Address

Name:
Address:
Phone:
-
Alternate Phone:
-
Are you 18 Years of age or older?
How did you hear about us:
Desired Salary:
Have you every been convicted of a felony?
If Yes, Please explain:

Job Type

Positions Applying for:

Days / Hours Available for Work

I am seeking:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Date Available to begin:
How many hours weekly can you work:

Additional Information:

Have you ever filed and application with us before?:
If Yes, date:
Have you ever been employed by this organization in the past?:
If yes, date:
I certify that I am a U.S. citizen, permanent resident , or foreign national with authorization to work in the United States:
If no, are you authorized to work in the U.S.?
Do you have a valid PA Drivers license?
Do you have proof of Insurance?
If the job requires, can you travel?
Distance willing to travel:

Education

High School:
College or Business / Trade School:
Describe any specialized training or skills:
Describe any job-related training received in the United States Military:
Are you a veteran of the United States Military?

Employment Experience

Start with your present or most recent employment experience.  Include any job-related military service assignments and volunteer activities.

Job 1: Organization:
Job 1: Supervisor:
Job 1: Hours / Week:
Job 1 Address
Job 1 Phone:
-
Job 1: Starting and Ending Date:
Job 1: Starting and Ending Salary:
Job 1: Last Job Title:
Job 1: Reason for Leaving:
Job 1: List job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company.
Job 1: May we contact this employer:

Past Employment History:  Job 2

Job 2: Organization:
Job 2: Supervisor:
Job 2: Hours / Week
Job 2: Address:
Job 2: Phone:
Job 2: Starting and Ending Date
Job 2: Starting and Ending Salary
Job 2: Last Job Title:
Job 2: Reason for leaving:
Job 2: List job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company.
Job 2: May we contact this employer:

Past Employment History: Job 3

Job 3: Organization
Job 3: Supervisor
Job 3: Hours / Week
Job 3: Address:
Job 3: Phone:
-
Job 3: Starting and Ending Date:
Job 3: Starting and Ending Salary:
Job 3: Last Job Title:
Job 3: Reason for leaving:
Job 3: List job you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company.
Job 3: May we contact this employer:

References

Reference 1: Name
Reference 1: Company
Reference 1: Address:
Reference 1: Phone:
-
Reference 1: Relationship

Reference 2

Reference 2: Name:
Reference 2: Company
Reference 2: Address:
Reference 2: Phone:
-
Reference 2: Relationship

Reference 3:

Reference 3: Name:
Reference 3: Company
Reference 3: Address:
Reference 3: Phone:
-
Reference 3: Relationship:

I certify that answers given herein are true and complete to the best of my knowledge.  I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision.  I hereby understand and acknowledge that any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge Employee and any said time with or without cause.  In event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Employer.

Please enter your full name:
Please enter todays date: