Employment Form

Personal Information

First Name (Required)

Last Name (Required)

Street Address

Street Address Line 2

City

State

Zip code

Phone Number (Required)

000-000-0000 or (000) 000-0000

Email Address (Required)

Social Security # (Required)

Required Information

Location Applying For (Required)

Select an option

Position Desired (Required)

Hourly Rate Desired (Required)

Have You Ever Worked For Lui Lui Before? (Required)

Select an option

If So, When and What Position?

Total Number of Hours Available per Week (Required)

Work Restrictions (Required)

How Will You Travel to Work? (Required)

When Can You Start?

Are You At Least 18 Years of Age? (Required)

Select an option

Are You Eligible of Employment in the US? (Required)

Select an option

How Long Have You Been in This Area? (Required)

How Long Do You Plan on Staying? (Required)

Previous Employment & References

Employer (Required)

Phone Number (Required)

000-000-0000 or (000) 000-0000

Street Address

Street Address Line 2

City

State

Zip code

Position Held (Required)

Dates Employed

starting month - ending month

Reason for Leaving (Required)

Employer (Required)

Phone Number (Required)

000-000-0000 or (000) 000-0000

Street Address

Street Address Line 2

City

State

Zip code

Position Held (Required)

Dates Employed

Reason for Leaving (Required)

Employer (Required)

Phone Number (Required)

000-000-0000 or (000) 000-0000

Street Address

Street Address Line 2

City

State

Zip code

Position Held

Dates Employed

starting month - ending month

Reason for Leaving

Referral

Who referred you to work with us?

Name

Phone Number

000-000-0000 or (000) 000-0000

Email Address