LEPI ENTERPRISES, INC.

630 G.W. MORSE STREET ZANESVILLE, OH 43701

EMPLOYMENT APPLICATION

NOTICE TO APPLICANT: We are an equal opportunity employer and do not discriminate on the basis of an applicant’s or employee’s race, color, religion, sex, national origin, citizenship, age, physical or mental disability or any other characteristic. Prior to employment, we perform Background Checks and Drug Screenings.


If yes, please submit ODH Certificate & License


Education (list from present to past)

School/Institution

Major / Area of Study

Degree / Number of Years


Employment History

Your application will not be considered with out a complete employment history.





EMERGENCY CONTACTS (In the event of an emergency, who should we contact?)


FORMER EMPLOYERS/BUSINESS RELATED REFERENCES

Name

Relation To Applicant

Telephone

Years Known


CRIMINAL HISTORY


OPTIONAL INFORMATION



ACKNOWLEDGEMENT (please read carefully)

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by the organization unless I have indicated to the contrary. I authorize the references listed above to provide the company any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the company as well as from the use or disclosure of such information by the organization or any of its agents, employees or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.