Lomod Form PDF Details

In the heart of Los Angeles, the Los Angeles LOMOD Corporation stands as a beacon for non-profit excellence and a staunch advocate for employment equality and affirmative action. This organization’s commendable efforts are encapsulated in their application process, designed with a keen eye for inclusivity and a commitment to comprehensive assessment. Applicants are invited to share not only their professional experiences and academic achievements but also personal aspects that might contribute to the rich tapestry of the corporation’s workforce. From language skills that transcend English to the candid disclosure of past convictions, the form seeks to uncover the multifaceted identities of its potential employees. Moreover, the attention to detail in requesting information on military service and the type of discharge underscores the depth of evaluation to which each application is subjected. The provision for applicants to list any disabilities alongside the option for accommodation further highlights the organization’s dedication to equal opportunity employment. With sections that delve into the applicator's past employment, licenses, certificates, and even voluntary experiences, the LOMOD application form is a thorough document that exemplifies an earnest pursuit of talent untainted by prejudice, ensuring that every individual, regardless of background, is given a fair chance to contribute to the corporation’s mission.

QuestionAnswer
Form NameLomod Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesLOMOD, ACCOMODATION, lomod org section 8, climate credit

Form Preview Example

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

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR PRESENT EMPLOYER FOR A REFERENCE?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S NAME AND ADDRESS

 

 

 

 

 

 

HAVE YOU EVER BEEN DISCHARGED OR TERMINATED FOR ANY REASON

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

NO

 

 

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

 

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.

 

 

 

 

ELIGIBILITY

 

 

 

 

REASON REJECTED

SPEC LIC

 

 

 

 

 

 

 

 

 

 

MIN. AGE

 

 

 

 

 

 

 

 

 

CIT.

 

 

 

 

 

 

DATE

 

APPLICATION APPROVED BY:

APP. ALIEN

 

REJECTED

 

 

 

 

BY:

 

 

SPEC

 

 

 

 

QUALS

 

 

 

DATE APPROVED:

 

 

 

 

 

 

 

 

 

 

DID YOU GRADUATE FROM

 

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

 

HIGH SCHOOL?

 

 

 

TEST?

 

 

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

FROM (Mo. & Yr.)

NAME OF PRESENT OR LAST EMPLOYER

YOUR TITLE

 

 

 

 

TO (Mo. & Yr.)

ADDRESS

 

DUTIES

 

 

 

 

TOTAL MONTHS WORKED

CITY AND STATE

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

 

 

 

 

 

__________

 

 

 

 

 

 

 

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

Filling in segment 1 in ACCOMODATION

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.

Writing segment 2 of ACCOMODATION

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.

Completing part 3 of ACCOMODATION

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!

Filling in part 5 of ACCOMODATION

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