General Application

- General Information -

Should you need reasonable accommodation when completing the application form or during the selection process, contact the Human Resources Department or other designated company representative. Information provided on this application will be kept confidential and only be shared with those involved in the selection process. Please provide all information requested. Incomplete information may disqualify you from consideration. Lee Agency, Inc. is an Equal Opportunity Employer.

Date*

Name*

First Middle Last

Address*

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

Email*

Phone*

Are you 18 years or older?*

Yes
No

Are you legally Authorized to work in the United States?*

Yes
No

As required by law, documents that prove identity and eligibility to work must be provided at the time of hire.

- Employment Desired -

Position Applying For:*

Do you want to work:*

Full-Time
Part-Time
Temporary

If part-time, specify days and hours available:

Date Available to Start Work*

Salary Expectations*

Have you ever applied for employment with us before?*

Yes
No

If you answered yes to the above, please list the date and position applied for.

Have you ever worked for us before?*

Yes
No

If you answered yes to the above, please provide your name of record at that time, job title and dates of employment.

- Education -

Highest Level of Education Completed*

School Name & Location (Of selected above)*

List Majors, Minors & Special Designations*

Special Skills/Additional Training

Please describe any special job-related skills and qualifications acquired from employment, other education or volunteer experiences, etc. Do not include experiences which would indicate race, religion, sex, national origin, genetic information, disability or age or any other status protected by law or regulation.

- Employment History -

Please provide your employment history, starting with your present or most recent position first.

Has your employment with any employer ever been involuntarily terminated?*

Yes
No

If yes, please identify the employer(s), date of termination(s) and reason(s) for termination.

Name of Employer 1

Position

Dates Employed (From - To)

Reason For Leaving

Brief Description of Work and Responsibilities

If present employee, may we contact this employer?

Yes
No

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Email

Employer Phone

Supervisor Name

First Last

Supervisor Title

Name of Employer 2

Position

Dates Employed (From - To)

Reason For Leaving

Brief Description of Work and Responsibilities

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Email

Employer Phone

Supervisor Name

First Last

Supervisor Title

Name of Employer 3

Position

Dates Employed (From - To)

Reason For Leaving

Brief Description of Work and Responsibilities

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Email

Employer Phone

Supervisor Name

First Last

Supervisor Title

Please Upload Your Resume and/or Cover Letter*

Drop files here or

Max. file size: 300 MB.

- Signature -

APPLICANT: Please read the following carefully before signing this application. • I certify the information given by me is true in all respects. • I understand that the misrepresentation or omission of facts on this application, on my resume or during any stage of the hiring process may eliminate me from further consideration or if discovered after hire may result in the termination of my employment. • I understand that the information contained in this employment application or my being invited to participate in any stage of the hiring process is NOT intended to create an employment contract between this Company and myself. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason or no reason, with or without notice, and this Company has the right to terminate my employment at any time, for any reason or no reason, with or without notice. This Company’s policies and procedures, including employment at-will, cannot be modified in any way without express written intent to do so by the senior business leader of this organization. • I understand that an offer of employment is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. • Unless otherwise noted above, I authorize this Company and its representatives to contact my prior employers, former supervisors and company personnel, schools and all others for the purpose of verifying the information I have supplied during the selection process and for obtaining job-related information regarding my knowledge, skills, abilities, performance of duties and compliance with policies. I authorize my prior employers to provide this Company any job-related information, personal or otherwise, they may have regarding me and I release this Company and them from any liability resulting from the release of this information. I further authorize all employers, schools and other persons to provide any information or transcripts that may be requested by this Company which will be used to determine if I am qualified to perform the job duties for which I am applying. • I understand that the company may conduct a criminal background investigation of me for the position for which I am applying and that a separate authorization to do so will be required. A conviction is not an automatic bar to consideration and/or employment. By placing my name below, I acknowledge that I have read and understand the above statements.

Applicant's Electronic Signature*

First Middle Last

Date*

Click Submit to Complete Final Step!

Upon submitting this portion of your application, you will be redirected to the final step of our application, the Culture Index Assessment. Once completed, our team will reach out to you within the next two weeks. Thank you for your interest in our organization!

Employment Application

- General Information -

- Employment Desired -

- Education -

- Employment History -

- Signature -

Click Submit to Complete Final Step!

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