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Question	Answer
Form Name	Lomod Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	LOMOD, ACCOMODATION, lomod org section 8, climate credit

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LOS ANGELES LOMOD CORPORATION

ANon-Profit Corporation 2600 Wilshire Blvd., 5th Floor

Los Angeles, CA 90057

AN EQUAL EMPLOYMENT OPPORTUNITY – AFFIRMATIVE ACTION EMPLOYER

JOB TITLE:

DATE:

NAME: LAST

FIRST

MIDDLE

SOCIAL SECURITY NO.

DATA

PRESENT ADDRESS NUMBER

STREET

BUSINESS PHONE

ext.

PERSONAL

CITY

SATE

ZIP CODE

HOME PHONE

WHAT LANGUAGE(S) DO YOU SPEAK OTHER THAN ENGLISH?

WOULD YOU OBJECT TO THE HUMAN RESOURCES DEPT CONTACTING

YES

YOUR PRESENT EMPLOYER FOR A REFERENCE?

฀

INFORMATION

EMPLOYER’S NAME AND ADDRESS

HAVE YOU EVER BEEN DISCHARGED OR TERMINATED FOR ANY REASON

YES

OTHER THAN LAYOFF FOR LACK OF WORK OR HAVE YOU EVER RESIGNED

฀

TO AVOID DISCHARGE? HAVE YOU EVER RECEIVED A GENERAL OR

DISHONERABLE DISCHARGE FROM THE MILITARY SERVICE? (CITE ALL

GENERAL

CASES ATTACH ADDITIONAL SHEET IF NECESSARY.)

DATE

REASON FOR DISCHARGE

DO YOU HOLD ANY ELECTIVE OR APPOINTED GENERAL OFFICE:

YES

OFFICE AND JURISDICTION

FEDERAL, STATE OR LOCAL?

฀

APPLICATION Page 1 of 4

LOS ANGELES LOMOD CORPORATION

2600 WILSHIRE BLVD., 5TH FLOOR

LOS ANGELES, CA 90057

APPLICATION FOR EMPLOYMENT

AN EQUAL EMPLOYMENT OPPORTUNITY – AFFIRMATIVE ACTION EMPLOYER

LIST DRIVER’S	TITLE
LICENSE AND OTHER
LICENSES AND
CIRTIFICATES
REQUIRED BY THE	___________________________________
EXAMINATION
BULLETIN.
	NUMBER	EXPIRATION DATE

Have you ever been convicted of a felony or misdemeanor other than minor traffic violations? (Drunk, reckless or hit-run driving are not minor driving violations.) The fact that you have a record may not prevent you from getting a job, but you may lose your chance for this job if you do not list all convictions. You may be fingerprinted and your complete police record reviewed. (Failure to admit is cause for disqualification.)

WRITE YES OR NO

__________________________

LIST ALL CONVICTIONS BELOEW AND ON ATTACHED SHEET IF

NECESSARY

	OFFENSE	DATE

	LOCATION	FINE OR SENTENCE

	OFFENSE	DATE

	LOCATION	FINE OR SENTENCE

		I certify that all statements on this application are true and
		complete to the best of my knowledge. I authorize
		investigation of all statements contained in this application.
		Ii understand false or incomplete statements shall be
		sufficient cause for disqualification or dismissal.
	Certification
	Certification	Signature
		Signature
		______________________________________
		Date _______________

		LIST ALL NAMES USED IN THE LAST TEN YEARS

		DO NOT WRITE BELOW THIS LINE

	STAFF NOTES:			LANG

				EDUC

REVIEW				EXP

				DR. LIC.
				DR. LIC.
ELIGIBILITY
ELIGIBILITY	REASON REJECTED			SPEC LIC
	REASON REJECTED			SPEC LIC

				MIN. AGE

				CIT.

	DATE		APPLICATION APPROVED BY:	APP. ALIEN
	REJECTED
	BY:			SPEC
				QUALS
			DATE APPROVED:	QUALS
			DATE APPROVED:

DID YOU GRADUATE FROM

IF NOT, HAVE YOU PASSED A G.E.D.

HIGH SCHOOL?

TEST?

YES

฀

EDUCATION

฀

YES

฀

CREWS

UNITS

SPECIFY

NAME AND LOCATION OF COLLEGE

COMPLETED

MAJOR SUBJECT OR

COMPLETED

DEGREES OR

OR TRADE SCHOOLS ATTENDED

SEM. UNITS OR QTR.

COURSE

IN MAJOR

CERTIFICATES

UNITS

AWARDED

APPLICATION Page 2 of 4

EXPERIENCE Begin With Your Most Recent Job. LIST ALL JOBS AND ANY PERIODS OF UNEMPLOYMENT IN THE LAST 10 YEARS. INCLUDE MILITARY SERVICE. ALSO LIST ANY JOBS YOU HELD MORE THAN 10 YEARS AGO WHICH RELATE TO THE DUTIES OF THE JOB FOR WHICH YOU ARE APPLYING AND INDICATE THE NUMBER OF HOURS PER WEEK THAT YOU WORKED. ALSO LIST ANY VOUNTEER EXPERIENCE AT ANY TIME WHICH RELATES TO THE JOB FOR WHICH YOU ARE APPLYING ALL EXPERIENCE USED TO QUALIFY FOR A POSITON EITHER PAID OR VOLUNTEER MUST BE VERIFIABLE.

DATES	EMPLOYERS		DUTIES
DATES
FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

FROM (Mo. & Yr.)	NAME OF PRESENT OR LAST EMPLOYER		YOUR TITLE

TO (Mo. & Yr.)	ADDRESS		DUTIES

TOTAL MONTHS WORKED	CITY AND STATE
TOTAL MONTHS WORKED
__________

MONTHLY SALARY	SUPERVISOR’S NAME	PHONE

			REASON FOR LEAVING

OTHER PERTINENT EXPERIENCE LIST OTHER EXPERIENCE PAID OR VOLUNTEER, PERTINENT TO THE POSITION FOR WHICH YOU ARE APPLYING AND WHICH HAS NOT BEEN ENTERED ABOVE. PLEASE INCLUDE SKILLS ACQUIRED DURING U.S. MILITARY SERVICE.

FROM

TO ________________

MONTHLY SALARY $ ____________

EMPLOYER

___________________

TITLE	DUTIES
_____________________	____________________

APPLICATION Page 3 of 4

CONFIDENTIAL INFORMATION

WILL BE KEPT SEPARATE

SEX

฀ MALE

฀ FEMALE

AGE _______

THE FOLLOWING INFORMATION IS NECESSARY FOR THE LOS ANGELES LOMOD CORPORATION TO EVALUATE ITS HIRING PRACTICES AND TO PREPARE REPORTS REQUIRED FOR THE STATE AND FERERAL GOVERNMENT. THIS FORM WILL BE DETACHED FROM THE APPLICATION AND THE INFORMATION CONTAINED THEREIN WILL NOT BE USED IN DETERMINING YOUR EMPLOYMENT. YOUR COOPERATION IS APPRECIATED.

ETHNIC GROUP/RACE
฀ CAUCASIAN	฀ HISPANIC	฀ AMERICAN INDIAN OR ALASKAN NATIVE
฀ BLACK	฀ ASIAN OR PACIFIC ISLANDER	฀ OTHER

฀ DISABILITY ACCOMODATION?

EXPLAIN ____________________________________________________________

NAME_________________________________________________

JOB TITLE: __________________________________________________________

HOW DID YOU HEAR ABOUT THE POSITIONS HERE AT LA LOMOD?

NEWSPAPER INTERNET SITE RADIO

WORD OF MOUTH

WHICH ONE?

฀ ________________________________

APPLICATION Page 4 of 4

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Step 2: The editor offers you the opportunity to customize the majority of PDF files in various ways. Modify it with any text, adjust original content, and put in a signature - all when you need it!

This PDF will require particular data to be entered, therefore make sure you take some time to type in what's expected:

1. The la lomod climate credit will require certain information to be typed in. Make certain the following fields are completed:

2. When the prior part is done, go to enter the relevant details in all these - WOULD YOU OBJECT TO THE HUMAN, DO YOU HOLD ANY ELECTIVE OR, EMPLOYERS NAME AND ADDRESS DATE, REASON FOR DISCHARGE, OFFICE AND JURISDICTION, N O T A M R O F N, I L A R E N E G, and APPLICATION Page of.

3. This next step is all about LIST DRIVERS LICENSE AND OTHER, TITLE NUMBER, EXPIRATION DATE, Have you ever been convicted of a, I certify that all statements on, Signature Date LIST ALL NAMES, n o i t a c i f i t r e C, LIST ALL CONVICTIONS BELOEW AND ON, DO NOT WRITE BELOW THIS LINE, NECESSARY, STAFF NOTES, OFFENSE, LOCATION, DATE, and FINE OR SENTENCE - type in all of these blank fields.

4. To move ahead, your next form section involves typing in a couple of form blanks. These comprise of LOCATION, OFFENSE, LOCATION, EDUCATION, NAME AND LOCATION OF COLLEGE, OR TRADE SCHOOLS ATTENDED, APPLICATION Page of, DATE, FINE OR SENTENCE, W E I V E R Y T I L I B G I L E, DATE REJECTED BY, APPLICATION APPROVED BY, DATE APPROVED, LANG EDUC EXP DR LIC SPEC LIC MIN, and DID YOU GRADUATE FROM HIGH SCHOOL, which you'll find key to going forward with this form.

Best ways to prepare ACCOMODATION part 4

As for NAME AND LOCATION OF COLLEGE and EDUCATION, ensure that you take another look in this current part. Both these are the most important ones in the document.

5. To finish your document, the particular subsection includes some extra fields. Completing APPLICATION Page of will finalize the process and you'll be done in a snap!

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