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Application for Employment
LifeStart, Inc. is an Equal Opportunity Employer
All sections/blanks on the
application must be completed.
Please check the boxes below to indicate your
availability for work on that day/time.
Leave non-available days/times unchecked.
Click day to check entire
Please complete all applicable fields.
Leave non-applicable fields blank.
SPECIAL SKILLS &
Summarize special job-related skills and
qualifications acquired from employment or other
LIST PROFESSIONAL, TRADE,
BUSINESS, OR CIVIC ACTIVITIES AND OFFICES HELD.
ALSO LIST ALL VOLUNTARY TIME
You may exclude memberships which would reveal sex,
race, religion, national origin, ancestry, handicap, or
other protected status.
Give name and telephone number of four references who have credentials, licenses, or
are community leaders such
as teachers, coaches, religious leaders, or club
Please give complete full-time and part-time
employment record. Start with your present or most
recent employer. Please explain any gaps in
(does not necessarily prohibit employment)
I confirm that information provided on
this Application for Employment is true, correct, and
complete. If employed, any misstatement or
omission of fact on this application may result in my
I understand that terms of my employment
will be based on a positive background check and
fingerprinting results from the Bureau of Criminal
Investigation and Identification, reference checks, and
driver safety records.
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