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?