Employment Application - Lamson Dugan & Murray LLP

Position Applying For

Choose One

Personal Information

Name (Last Name, First Name, Middle Initial)

Social Security Number

Present Address

Street Address Address Line 2 City State ZIP Code

Permanent Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

How did you hear about LDM?

Employment Desired

Position

Date You Can Start

Salary Desired

Ever Applied to LDM Before?

If YES, Where?

If YES, When?

Are You Currently Employed?

May We Contact Your Employer?

What Hours Are You Available To Work?

Education

High School

Name & Location of School

Years Completed

Did You Graduate?

Subjects Studied

GPA

College

Name & Location of School

Years Completed

Did You Graduate?

Subjects Studied

GPA

Other Schools

Name & Location of School

Years Completed

Did You Graduate?

Subjects Studied

GPA

U.S. Military or Naval Service?

Branch, Rank, Location, Other

Have You Been Convicted of a Felony in the Last 7 Years?

If YES, Please explain

Conviction will not necessarily disqualify you from employment.

Are You Eligible to Work in the United States?

To ensure no conflict of interest with clients of the Firm, please state if you are currently engaged in any civil lawsuits or intend to file any civil lawsuit in the next 90-days. The Firm is not seeking information regarding, and you should exclude from your answer, any unemployment or worker’s compensation claims or lawsuits.Conflicts

Yes
No

Please identify the parties to the lawsuit excluding any unemployment or workers compensation claims or lawsuits.

Note – current or potential lawsuits will not necessarily disqualify the applicant from employment.

References

Reference 1

Name

First Last

How Do You Know This Person?

Years Known

Please enter a number from 0 to 150.

Reference Phone

Reference Email

Reference 2

Name

First Last

How Do You Know This Person?

Years Known

Please enter a number from 0 to 150.

Reference Phone

Reference Email

Reference 3

Name

First Last

How Do You Know This Person?

Years Known

Please enter a number from 0 to 150.

Reference Phone

Reference Email

Employment History

Employer 1

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

End Date

Starting Salary

Ending Salary

Positions Held

Most Recent Supervisor

First Last

Phone

Email

Reason for Leaving

May We Contact?

Employer 2

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

End Date

Starting Salary

Ending Salary

Positions Held

Most Recent Supervisor

First Last

Phone

Email

Reason for Leaving

May We Contact?

Employer 3

Name of Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Start Date

End Date

Starting Salary

Ending Salary

Positions Held

Most Recent Supervisor

First Last

Phone

Email

Reason for Leaving

May We Contact?

List Any Special Skills or Training You Have Received

List Any Memberships in Job-related Professional Organizations

Any Additional Information

Upload Resumé

Resumé file

Max. file size: 256 MB.

Authorization*

I agree to the authorization statement below.

I, the undersigned, certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Fair Credit Reporting Act (FCRA) Disclosure regarding the Procurement of Consumer and Investigative Consumer Reports

As required by the Fair Credit Reporting Act (FCRA), we advise you that, in connection with your application for employment or, if employed by Lamson Dugan & Murray, LLP, your eligibility for continued employment, promotion, or any other employment purpose, we may obtain a consumer report, regarding your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, with respect to you for employment purposes from a consumer reporting agency.

Fair Credit Reporting Act (FCRA) Authorization to Obtain Consumer Reports*

I agree to the authorization below to obtain consumer reports.

I understand that Lamson Dugan & Murray LLP or a third-party, consumer reporting agency acting on its behalf may conduct an investigation to obtain information about my background for the purposes of determining by my eligibility for employment or, if I am employed by Lamson Dugan & Murray, LLP, my eligibility for continued employment, promotion, or any other employment purpose, including, but not limited to the following information: information about my personal character, previous employment, general reputation, educational background, credit history, driving record, and/or criminal history. I authorize all persons; corporations; credit agencies; educational institutions; law enforcement agencies; city, state, county, and federal courts; and military services to release any such information about my background. Moreover, I authorize any person or entity conducting the investigation or compiling and/or processing such information to furnish the company, and/or any third party acting on the company's behalf, with such information. I further understand that the company will provide me with written notice if any adverse employment action is to be taken based in whole or in part on information contained in a consumer report within the meaning of the Fair Credit Reporting Act.

Today's Date*

Re-enter Your Full Name to Acknowledge Consent, then Sign Below

Signature*