Online Application Application LAKESIDE METAL SPECIALTIES, INC. LAKESIDE CONSTRUCTION FASTENERS, INC. Employment Application Applicant InformationFirst Name* Last Name* Today's Date* MM slash DD slash YYYY Street Address Apartment # / Suite City* State* Zip* Phone*Email* Date Available* MM slash DD slash YYYY Desired Salary* Position Applied For* Are you a citizen of the United States?* Yes No If not, are you authorized to work in the U.S.? Yes No Have you ever worked for this company?* Yes No If so, when? Have you ever been convicted of a felony?* Yes No If so, when? Within the last 5 years have you been convicted of or released from incarceration for a misdemeanor which was not a first offense for, drunkenness, simple assault, speeding, a minor traffic violation, or disturbing the peace? Yes No EducationHigh School Address Dates Did you graduate? Yes No Degree College Address Dates Did you graduate? Yes No Degree Other Address Dates Did you graduate? Yes No Degree ReferencesFull Name Address Company Phone Relationship Full Name Address Company Phone Relationship Full Name Address Company Phone Relationship Work Experience (Beginning with the current or most recent)Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities Dates Reason for leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities Dates Reason for leaving May we contact your previous supervisor for a reference? Yes No Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities Dates Reason for leaving May we contact your previous supervisor for a reference? Yes No Military ExperienceBranch Dates Rank at Discharge Type of Discharge If other than honorable, explain Emergency ContactName Relationship Telephone Cell Phone Additional Information Disclaimer and SignatureI certify that all answers and statements given by me are true and correct without reservations of any kind and that no attempt has been made by me to conceal pertinent information. I hereby consent to allow Lakeside Metal Specialties, Inc./Lakeside Construction Fasteners, Inc. to perform a background check. If employed, I will comply with all company regulations. I authorize my former employers, schools, and references to give any job-related information they may have regarding me. I hereby release them and their companies from all liability for issuing such information. If upon investigation anything on this application is found to be false, misleading, or detrimental to the company’s operations in any way, I understand that I will be subject to dismissal from employment at any time during my period of employment. Lakeside Metal Specialties, Inc./Lakeside Construction Fasteners, Inc. participates in E-Verify to make employment eligibility determinations in accordance with federal agencies. I fully understand that any offer of employment will be subject to the company’s regulations regarding physical examinations, security investigations, and any other qualifying tests required. If such an investigation and report is made, I understand that I have the right to make a request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.Signature Date DO NOT WRITE BELOW THIS LINEInterviewed by Neatness Ability Hired By Start Date Salary PhoneThis field is for validation purposes and should be left unchanged.