J. Lewis Cooper Co. - Application for Employment:

We are an Equal Opportunity Employer. We comply with all applicable Federal, State, and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law.

Your application cannot be processed unless the authorization forms (additional pages) are printed, completed and then faxed or sent back to us.

You may also email a text version of your resume to hr@jlewiscooper.com.

Position(s) Applied for:
First Name: Last Name: Middle Init:
Address Line #1:
Address Line #2:
City: State/Providence: Zip/Postal Code:
Country: Telephone # with area code:
e-mail address: Drivers License #:
(Any position may require this)
Date Available for work:
Employment Type: Full Time Part Time Temporary Seasonal Co-op
(Check all that may apply)
Were you previously Employed by J. Lewis Cooper Co.? No or Yes
If Yes, Date(s):
Department/Position:

List any relatives or friends working for J. Lewis Cooper Co. and their relationship to you.

WORK EXPERIENCE - LIST PRESENT AND FORMER EMPLOYERS BEGINNING WITH MOST RECENT

Work Reference #1:
From MO/YR: To MO/YR:
Company Name & Address:
Telephone #: Last Position Held:
Supervisor's Name: Supervisor's Title:
Describe Your Work:

Last Wages: per: Reason for leaving:
May we contact this employer: No or Yes

Work Reference #2:
From MO/YR: To MO/YR:
Company Name & Address:
Telephone #: Last Position Held:
Supervisor's Name: Supervisor's Title:
Describe Your Work:

Last Wages: per: Reason for leaving:
May we contact this employer: No or Yes

Work Reference #3:
From MO/YR: To MO/YR:
Company Name & Address:
Telephone #: Last Position Held:
Supervisor's Name: Supervisor's Title:
Describe Your Work:

Last Wages: per: Reason for leaving:
May we contact this employer: No or Yes

Work Reference #4:
From MO/YR: To MO/YR:
Company Name & Address:
Telephone #: Last Position Held:
Supervisor's Name: Supervisor's Title:
Describe Your Work:

Last Wages: per: Reason for leaving:
May we contact this employer: No or Yes

Have you ever served an Apprenticeship? No or Yes
If yes where?
Type of Trade: Dates:

Please list your skills & qualifications - Mechanical and/or Technical Experience and abilities relevant to the position for which you are applying.


EDUCATION

High School Name & Location:
No. of years completed: Did you Graduate: No or Yes
Course of Study:

College Name & Location:
No. of years completed: Did you Graduate: No or Yes
Degree:

Other Education & Location:
No. of years completed: Did you Graduate: No or Yes
Course of Study:

REFERENCES

Name
Relationship
Phone #
Years Known

MISCELLANEOUS INFORMATION

Have you ever been convicted of a crime in the past 7 years, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court?
(A conviction record will not necessarily be a bar to employment.) No or Yes

If yes please explain and describe in full detail:


Can you verify your legal rights to work in the U.S. by providing a birth certificate, proof of U.S. Citizenship, or by some other means? No or Yes
If you are under 18, are you able to furnish a work permit? No or Yes

APPLICANT'S CERTIFICATION - PLEASE READ CAREFULLY

I certify that the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that, if I become employed, a misrepresentation or omission of fact in this application may result in my discharge from employment.

I authorize the J. Lewis Cooper Co., as part of its evaluation of my suitability for employment, to contact all school officials, references, and my previous supervisors to secure information concerning my skills, character and ability.

I further acknowledge and agree that no manager or representative of the Company has any authority to enter into any employment agreement.

I understand and agree that, if I am employed, I will be an at-will employee and the Company may terminate my employment at any time and for any or no reason without prior notice.

I Hereby Waive My Right To Written Notice By My Previous And/Or Present Employers Whenever A Report Of Disciplinary Action Or Reprimand Regarding Me is Divulged To You By Previous Or Present Employers.


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Your application cannot be processed unless the authorization forms (Additional required pages, click Here) are printed, completed and then faxed or sent back to us.