		Employment Application
		Human Resources Department 2202 Ridgewood Drive Midland, MI 48642 Phone: (989) 631-8030 Fax: (989) 631-6102

Please fill out the following application to the best of your ability.

Name:	*		*
	First	Middle	Last
Location:	*	*	*	Telephone Number:	* - -
	City	State	Zip
Email Address: if available
Other Names Used in Prior Employment:
Are you at least 18 years of age or a High School Graduate? Yes No
Are you legally authorized to work in the United States of America? Yes No

Note: You will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.

LMS is an Affirmative Action and Equal Opportunity Employer

List below your last four employers beginning with your last or current employer	Salary or Wage: Specify Hourly or Yearly	Time Employed				Job Duties:	Reason For Leaving:
		From		To
		Mo	Yr	Mo	Yr
Employer:	Starting $
	Ending $
Address:
Phone:
Job Title:
Supervisor:

	Salary or Wage: Specify Hourly or Yearly	Time Employed				Job Duties:	Reason For Leaving:
		From		To
		Mo	Yr	Mo	Yr
Employer:	Starting $
	Ending $
Address:
Phone:
Job Title:
Supervisor:

	Salary or Wage: Specify Hourly or Yearly	Time Employed				Job Duties:	Reason For Leaving:
		From		To
		Mo	Yr	Mo	Yr
Employer:	Starting $
	Ending $
Address:
Phone:
Job Title:
Supervisor:

	Salary or Wage: Specify Hourly or Yearly	Time Employed				Job Duties:	Reason For Leaving:
		From		To:
		Mo	Yr	Mo	Yr
Employer:	Starting $
	Ending $
Address:
Phone:
Job Title:
Supervisor:


Invitation to Identify for Affirmative Action Purposes

LMS is committed to the employment and advancement of minorities, women, individuals with disabilities and veterans. If you fall into one of these protected classifications, we invite you to identify yourself and receive coverage under our company's Affirmative Action Plan. You may inform us of your desire to benefit under the program at this time and/or anytime in the future.
Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. This form is confidential will not be used in a manner inconsistent with the Acts.
Ethnicity:
Gender:

I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind. I agree that the company shall not be held liable in any respect if my employment is terminated because of false statements, answers, or omissions made by me on this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may be cause for termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular employment physical. I also authorize the companies, schools, or persons named above to give any information requested regarding my employment, character, and qualifications. I hereby release said companies, schools, or persons from all liability for any damage for issuing this information. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either my employer or myself.
Applicant Signature: *	Date:	*
Please enter your full name and the current date above.

Applying For:	*	Salary Desired: Specify Hourly or Yearly	ie: 15,000.00/yr or $10.50/hr
How were you referred to LMS?
Want Ad. What paper?
LMS Employee. Who?
Walk In - No Referral
Other - Explain:
Are you available for any shift? Yes No
Shift desired?
What type of employment are you seeking? Full Time Part Time Seasonal Internship/Co-op
Date available to start?
Names of friends or relatives employed at LMS:
Have you ever filed an application here before? Yes No If yes, when?
Have you ever been employed here before? Yes No If yes, when?
Are you willing to work overtime? Yes No

School:	High School	College	Graduate
School Name:
Years Completed:	9 10 11 12	1 2 3 4	1 2 3 4
Diploma/Degree:
Course of Study:
Specialized Training, Apprenticeship, Skills:

	Repair	Operate	Inspection Tools
Injection Molding Presses			Dial Indicator
Assembly Equipment			Gauge Blocks
Electrical Equipment			Plug Gauge
Electronic Equipment			Optical Comparator
Hydraulic Equipment			Measuring Microscope
Pneumatic Equipment			Coordinate Measuring Machine
Process Controllers			Micrometer
Drill Presses			Vernier Caliper
Lathes

Material Handling			Computer Operations
Power Lift Truck				Data Entry - Keystrokes per minute
Shipping				Typing - Words per minute
Receiving				Word-processing Software
Packing				Spreadsheet Software
Stocking				Presentation Software
Order Filling				Other:
Can you read blueprints?
Can you read electrical schematics?