Employment Application - Mountain Lake

Applicant Information

Name*

First Last

Address*

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

Email*

Phone*

File

Position Applied For:

Desired Salary:

Date Available to Start:

Are you authorized to work in the US?*

Yes
No

Have you ever worked for this company?

Yes
No

If so when?

Education

High School Attended:

Did you graduate?

Yes
No

College:

Did you graduate?

Yes
No

Degree:

Other education:

Current occupational or relevant licenses:

References

Please list 3 personal references, with phone number:*

Previous Employment

Most recent employer:

Company name, address, & phone number.

Dates Employed:

Job Title:

Responsibilities:

Starting/Ending Salary:

Reason for leaving:

Previous Employer:

Dates Employed:

Job Title:

Responsibilities:

Starting/Ending Salary:

Reason for leaving:

Previous Employer:

Dates Employed:

Job Title:

Responsibilities:

Starting/Ending Salary:

Reason for leaving:

Military Service

Have you ever served active duty in the Armed Forces or been a member of the Reserve Unit or the National Guard of the United States?:

Yes
No

Branch, Rank & Dates:

Background Information

Previous Residences:

Provide addresses & dates for the past 3 years.

Have you ever been arrested, charged, or received a summons to appear for any criminal law violation?:*

Yes
No

A 'yes' answer to these questions will not automatically disqualify you for employment.

If "yes", where?:

Charges:

Disposition & Date:

Have you ever been convicted of or had adjudication withheld for a felony or first degree misdemeanor?:*

Yes
No

A 'yes' answer to these questions will not automatically disqualify you for employment.

If "yes", where?:

Charges:

Disposition & Date:

Authorization

Initial:*

I authorize Mountain Lake Corp. or it's designated agents to investigate the truthfulness of all the statements made on my application or resume. I further authorize them to contact my former employers and any other persons who can verify information.

Initial:*

I understand that my employment with Mountain Lake Corp. is conditioned upon a successful background investigation. I give my consent for all contacted persons, including former employees, to provide information concerning this application for employment.

Initial:*

I hereby promise not to sue and do hereby release each such person from providing information to Mountain Lake Corp. and it's designated agent from any and all liability of any kind or nature whatsoever, for actions taken as part of processing my application for employment and the activities described in this document.

Initial:*

I affirm that the information provided in the application is true, correct, and complete. If employed, any misstatement or omission of facts on this application shall be grounds for refusal of employment, or if hired, dismissal from employment.

Type Name and Date:*

Typing name and date in the above box counts as a signature. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.