Employment Application

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L.O. Eye is an equal opportunity employer and it is our policy to ensure equal employment opportunity without discrimination or harassment on the basis of race, color, religion, sex, sexual orientation, age, disability, marital status, citizenship or anything else protected by law. Should an applicant need reasonable accommodation during the application and/or interview process, please notify the Human Resources office.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day Time Phone Number*
Email
Position Applying For
Are you legally eligible to be employed in the United States?*

Yes or No
Have you ever been employed with L.O. Eye Care before?

Yes or No - if yes, list dates and position.
Have you ever been convicted of a crime?

If yes, please explain.
Do you have any relatives or friends that work for L.O. Eye?

If yes, who?
Are you available to work full time or part time?
Do you use any form of tobacco?
High School Information
High school name and location
Trade/Professional School Information
Trade/Professional school name, location, and areas of study.
College/University Information
College/University name, location, areas of study.
Service Record - Branch of Service
Service Discharge Date
MM slash DD slash YYYY
Present Membership in National Guard or Reserves
Date Obligation Ends
Employment History - Employer 1
Include employer name, address, supervisor name, phone number, dates employed, job title, duties/responsibilities, hourly wage/salary, and reason for leaving.
Employment History - Employer 2
Employment History - Employer 3
Attach Coverletter
Accepted file types: gif, jpg, png, pdf, doc, docx, Max. file size: 3 MB.
Attach Resume
Accepted file types: gif, jpg, png, pdf, doc, docx, Max. file size: 3 MB.
Applicant Statement*

By typing your full name, you are agreeing to the following statements: I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered. I authorize the employer to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
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