Name * First Name Last Name Email Last 4 Digits of SSN * Primary Phone Number * (###) ### #### Secondary Phone Number (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you learn about us? Indeed.com Employment Agency Relative Friend Other Have you completed an application with us before? No Yes Are you currently employed? No Yes Did you receive a HSD or GED? * No HSD GED What shift are you available to work? * Any First Second Third Date available? * MM DD YYYY Do you have Forklift experience? No Yes Do you have Power Drill experience? * Yes No Do you have steel toe boots/shoes? * No Yes Previous Employer? (Job Title, Dates, Pay) Felony in the past? * No Yes If yes, charge and year? UPLOAD : 1st id UPLOAD : 2nd id If you prefer you can always email us your documents at no.reply@lomllc.net or visit our office between 8:00 AM - 4:00 PM. I hereby understand that as a condition of my employment I may be subjected to drug/alcohol screening for any of the following reasons: Pre-Employment, Post Hire, Post-Accident, Suspicion, Random Testing, Promotion, Transition, or Background Checks. If you acknowledge the above statement, please write your full name * Thank you for applying. If you have not already please email us your two forms of I.D. and HSD/GED at no.reply@lomllc.netAny questions please contact us at 334-215-2211
