EMPLOYMENT APPLICATION

APPLICANT INFORMATION

* Required Fields

Name*

Last

First

Middle

Address*

Street

City

State Zip

Home Phone*
(xxx-xxx-xxxx)

Other Phone
(xxx-xxx-xxxx)

Email*

Previous Addresses (for at least the past 5 years) If your address has remained the same as above please check here

Address	Street	City	State	Zip
Address	Street	City	State	Zip
Address	Street	City	State	Zip

Are you 18 years of age or older*

Yes

Do you have a legal right to work for Legacy Publishing Company in the U.S.?*

Yes

Have you been convicted of a crime that has not been annulled by a court?*

Yes

If “yes”, explain*

(Do not include information contained in a sealed or expunged record.)
NOTE: A conviction or guilty plea will not necessarily disqualify you from employment.

Have you ever been disciplined, suspended, discharged, or asked to resign from a job in connection with loss of money, merchandise, or equipment?*

Yes

If “yes”, explain*

Have you ever been disciplined or discharged for absenteeism or tardiness?

Yes

If “yes”, explain*

POSITION INFORMATION

Position Applied For:* Sales Other Position Desired:*
Preferred Location : Westbrook Auburn Date Available:
Name(s) of any relative(s) or friend(s) employed by Legacy Publishing/relationship:

Referral Source:

Employee Name:

Please Explain:

EDUCATION

Name of School	School City, State, Zip	Major	Diploma/Degree	Degree Yes/No

SKILLS & QUALIFICATIONS

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for a position with our company.

EMPLOYMENT HISTORY

List positions for the past 5 years beginning with most recent job and attach resume if applicable. (One Required)

Employer

Address

Phone

Last Position Held Supervisors Name

Reason for Change

Dates Employed
MM/YYYY	to	MM/YYYY

Annual Salary

Upload Resume ↑

REFERENCES:

List three references below, one should be a supervisor and one should be a co-worker:

Name	Working Relationship	Company	Address	Phone Number

APPLICANT’S STATEMENT:

I certify that the statements I have made on this application are true. I authorize investigation of all statements contained in this application and the references listed above as well as additional sources as may be necessary in arriving at an employment decision. I understand that false or misleading information given in my application or resume will be sufficient grounds for withdrawing my application or any outstanding job offer; or, if I am employed, for dismissing me from employment. I understand and agree that if I am employed by Legacy Publishing my employment will be at will and may be terminated by myself or the Company at any time with or without notice.

Check here that you have read.*