LPC Personnel, INC Submit by Email Print Form

Name(In Full) Date Consultant:

(Maintained 60 days)

Street Address

Position Desired: Salary Desired:

City State Zip Phone

Location: Temp?

Cell Phone# Cell Carrier Other

Referred to LPC by?

E-mail Address Skills/Experience: (Check those that apply)

Credit/Collections Accounting A/P, A/R Full Charge Bookkeeper

TDL# SS# Smoker

Payroll Data Entry Typing

Keystrokes WPM

Name and Address of School Major Course Graduate Grade Avg

High School Software: (Check those that apply)

MS PowerPoint MS Word MS Excel Outlook Quickbooks

College or University

SAP Other

Business or Trade

Write Read Speak

Other (Include Military) Foreign Languages

Describe duties, Skills and/or machines used.

Date Started Date Ended Starting Salary Ending Salary

Name of Company

Address Phone

Type of Business Supervisors Name Job Title:

Reason For Leaving Accomplishments:

Describe duties, Skills and/or machines used.

Date Started Date Ended Starting Salary Ending Salary

Name of Company

Address Phone

Type of Business Supervisors Name Job Title:

Reason For Leaving Accomplishments:

Describe duties, Skills and/or machines used.

Date Started Date Ended Starting Salary Ending Salary

Name of Company

Address Phone

Type of Business Supervisors Name Job Title:

Reason For Leaving Accomplishments:

Describe duties, Skills and/or machines used.

Date Started Date Ended Starting Salary Ending Salary

Name of Company

Address Phone

Type of Business Supervisors Name Job Title:

Reason For Leaving Accomplishments:

Yes No

Have you ever been convicted of a criminal offense or subject to deferred adjudication?

IN THE INTEREST OF GOOD BUSINESS RELATIONS, PLEASE READ AND UNDERSTAND THIS AGREEMENT BEFORE YOU SIGN IT. I List below employment agencies or

hereby employ LPC Personnel Inc. to represent, aid, inform, refer and counsel me in securing employment. This is authority to companies you have contacted in your

make investigation into the records of my past employment and other records which they may consider necessary. I do further job search.

release the agency from any liability of any type or character resulting from such investigations or any disclosures of

(1)

information learned as a result of such investigations. In the event that I choose to end an assignment early, I understand there

are costs associated with closing employee files and filing government forms. As a result, the amount of $125.00 may be

(2)

deducted from my final check. (I further understand that any and all information furnished by me to LPC Personnel Inc. is

CONFIDENTIAL.) I certify that all the information provided by me in connection with my application, whether on this document

or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds (3)

for refusal to hire or, if hired will result in immediate termination. Additionally, I hereby certify by my signature below that I

have read, understood, and agreed to the terms and conditions set forth above.

(4)

I agree I disagree

Date Signature

Office Use Only

Date Company Position Company Contact Results

Available for Interview?

Length of notice required?

Available for Temp Work?

Contact this candidate