Employment Center
Employment Center Information
Please Fill Out and Email To:
msliz4kidz@gmail.com or msliz4kidz@yahoo.com
L & L Specialty Therapy/Care Tec Pediatric Center,LLC Website
L & L Specialty Therapy, LLC
2834 Military Highway, Pineville, La 71360
318-451-3989 CENTER 318-704-5821 FAX
337-351-1841 ADMINISTRATION
Care Tec Pediatric Center, LLC
2840 Military Highway, Pineville, La, 71360
318-704-5304 CENTER 318-704-5821 FAX
337-301-1029 ADMINISTRATION
EMPLOYMENT APPLICATION
POSITION APPLIED FOR:_____________________________________ DATE OF APPLICATION:_______________________________
APPLICANT HOME PHONE:__________________ CELL or ALTERNATE PHONE:_______________
NAME:_____________________________________________________________________
LAST FIRST MIDDLE
ADDRESS:
______________________________________ ARE YOU LEGALLY ELIGIBLE FOR US EMPLOYMENT?
______________________________________ YES NO (IF YES VERIFICATION REQUIRED)
_______________________________________ I AM SEEKING A PERMANENT POSITION: YES NO
ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS IF NECESSARY, FOR THE JOB I AM ABLE TO:
MEET THE ADA REQUIREMENTS OF THE POSITION I AM APPLYING FOR , WITH OR WITHOUT ACCOMMODATION
PLEASE SPECIFY : WORK OVERTIME?
PROVIDE A VAILD DRIVER’S LICENSE?
IF NECESSARY FOR THE JOB, ARE YOU OVER (PLEASE MARK ONE) 16__ 18__ 19__ 21__
I WILL BE ABLE TO REPORT TO WORK ___ DAYS AFTER BEING NOTIFIED THAT I AM HIRED.
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EDUCATION:
HIGH SCHOOL
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YES COMPLETED
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FIELD OF STUDY
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GRADUATE OR DEGREE
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COLLEGE/UNIVERSITY
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BUSINESS/TECHNICAL
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OTHER (MAY INCLUDE GRAMMAR SCHOOL)
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MILITARY SERVICE: YES NO
DUTY/SPECIALIZED TRAINING:___________________________________________________________
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REFERENCES: LIST TWO PERSONAL REFERENCES WHO ARE NOT RELATIVES OR FORMER SUPERVISORS.
_________________________________________________________________________________________________________
NAME ADDRESS TELEPHONE OCCUPATION YEARS KNOWN
_________________________________________________________________________________________________________
NAME ADDRESS TELEPHONE OCCUPATION YEARS KNOWN
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EMPLOYMENT: LIST LAST EMPLOYMENT FIRST. INCLUDE SUMMER OR TEMPORARY JOBS. BE SURE ALL YOUR EXPERIENCE OR EMPLOYERS RELATED TO
THIS JOB ARE LISTED HERE, IN THE SUMMARY (FOLLOWING THIS SECTION) OR USE AN EXTRA SHEET OF PAPER IF NECESSARY.
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EMPLOYER NAME AND ADDRESS:
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POSITION TITLE/DUTIES SKILLS
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DATES EMPLOYED
 FROM TO
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REASON FOR LEAVING
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SUPERVISOR’S NAME: TELEPHONE
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EMPLOYER NAME AND ADDRESS:
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POSITION TITLE/DUTIES SKILLS
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DATES EMPLOYED
FROM TO
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REASON FOR LEAVING
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SUPERVISOR’S NAME: TELEPHONE
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EMPLOYER NAME AND ADDRESS:
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POSITION TITLE/DUTIES SKILLS
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DATES EMPLOYED
FROM TO
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REASON FOR LEAVING
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SUPERVISOR’S NAME: TELEPHONE
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EMPLOYER NAME AND ADDRESS:
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POSITION TITLE/DUTIES SKILLS
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DATES EMPLOYED
FROM TO
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REASON FOR LEAVING
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SUPERVISOR’S NAME: TELEPHONE
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SUMMARIZE OTHER EMPLOYMENT RELATED TO THIS JOB__________________________________________________
TYPES OF COMPUTERS, OTHER ELCTRONIC, OR MECHANICAL EQUIPMENT THAT YOU ARE QUALIFIED TO OPERATE OR REPAIR:__________________________________________________________________________________________
PROFESSIONAL LICENSES, CERTIFICATIONS OR REGISTRATIONS: _____________________________________________
ADDITIONAL SKILLS INCLUDING SUPERVISION SKILLS, OTHER LANGUAGES, OR INFORMATION REGARDING THE CAREER/OCCUPATION YOU WISH TO BRING TO THE EMPLOYER’S ATTENTION______________________________________________________________________________________
_______________________________________________________________________________________________________________________
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