Landdesign Surveying Services
LDSI, Inc.
508 West 5th Street, Suite 125
Charlotte, North Carolina 28202
Application for Employment
Date: ______Social Security Number: ______
Last Name: ______First Name: ______
Address: ______
City: ______State: ______Zip Code: ______
Home Phone: ______Business Phone: ______
Position Sought: ______Desired Wage: ______
Are you available for full-time work? ______
Will you work overtime if asked? ______
When will you be available to begin work? ______
Are you available for out of town work on a regular basis? ______
Employment Experience
Present or most recent position:
Company Name: ______Telephone: ______
Address: ______
Name of Supervisor: ______Wages: ______
Employed (State month and year): From ______To ______
State Job Title and Describe Your Primary Duties: ______
Reason for Leaving: ______
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Prior position #1:
Company Name: ______Telephone: ______
Address: ______
Name of Supervisor: ______Wages: ______
Employed (State month and year): From ______To ______
State Job Title and Describe Your Primary Duties: ______
Reason for Leaving: ______
Prior position #2:
Company Name: ______Telephone: ______
Address: ______
Name of Supervisor: ______Wages: ______
Employed (State month and year): From ______To ______
State Job Title and Describe Your Primary Duties: ______
Reason for Leaving: ______
Prior position #3:
Company Name: ______Telephone: ______
Address: ______
Name of Supervisor: ______Wages: ______
Employed (State month and year): From ______To ______
State Job Title and Describe Your Primary Duties: ______
Reason for Leaving: ______
May we contact the employers listed above? ______
If not, please list any that you do not want contacted and reason? ______
Education:
High School:
Name: ______Location: ______
Course of Study: ______Did You Graduate: ______
Years Completed: ______Degree/Diploma: ______
Business/Trade/Technical:
Name: ______Location: ______
Course of Study: ______Did You Graduate: ______
Years Completed: ______Degree/Diploma: ______
College:
Name: ______Location: ______
Course of Study: ______Did You Graduate: ______
Years Completed: ______Degree/Diploma: ______
Graduate/Professional:
Name: ______Location: ______
Course of Study: ______Did You Graduate: ______
Years Completed: ______Degree/Diploma: ______
Please list any other special training or skills: ______
Important Please Read
- I hereby affirm that the information provided on this application (and accompanying transcript and resume, if any) is true and complete to the best of my knowledge and agree that falsified or misleading information or significant omissions may disqualify me from further consideration and may be cause for dismissal if discovered at a later date.
- I hereby authorize former and present employers and others to give or verify any information they have regarding me or my employment with them, and I release them and their companies from any liability for damage resulting wherefrom.
- I also understand that any employment which may result with LDSI, Inc., can be terminated, with or without cause and with or without notice, at any time, at the option of either LDSI, Inc., or myself.
- I understand that offers of employment are conditioned upon successful passing of a drug test as scheduled by LDSI, Inc.
- We are an Equal Employment Opportunity Employer. Consideration for employment is based solely on individual qualifications, without regard to race, marital status, religious creed, color national origin, ancestry, physical handicap, medical condition, sex, sexual orientation, age, or any other protected category recognized by applicable federal, state and local laws.
Signature: ______
Date: ______
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