Employment Application

607-775-0600

113 Court Street Binghamton, NY 13901

Position applied for *

First Name *

References: Please list three references: please include their occupation, relationship to you and contact phone numbers: *

Application for Employment

This application must be completed by the applicant. Each question must be answered in full. If answer is 'no' or 'none', indicate such. William H. Lane Incorporated considers all applications without regard to race, color, gender, age, religion, national origin, veteran status, sexual orientation or any other basis protected by federal, state or local laws. We appreciate your interest in our company.

Availability: Evenings: *

Yes

Email *

Availability: Part Time: *

Yes

Other positions qualified for: *

Previous Address *

Desired rate of pay per week: *

Are you at least 18 years of age? *

Yes

Licenses or certifications held:

Availability: Days: *

Yes

Middle Initial *

If yes, please provide the specific nature and details of the crime(s), date(s), court location(s), sentencing information and disposition of sentence. Please note: The organization reserves the right to reject individuals for employment regarding job related convictions. A conviction record will not necessarily be a bar to employment: factors such as the seriousness and nature of the violation and rehabilitation will be taken into account.

Employment History: Please provide information on your three most recent employers including: Company name, address and phone number, nature of the business, your title, Supervisor's name, dates of employment, brief description of duties and reason for leaving. *

Upload Resume

Current Address *

Last Name: *

Have you ever been employed by William H. Lane Incorporated? *

Yes

Availability: Nights: *

Yes

Phone *

Availability: Full Time: *

Yes

Have you ever been convicted of and/or plead guilty to a felony or misdemeanor? *

Yes

Are you currently employed? *

Yes

Upload Cover Letter

Are you legally eligible for employment in the United States? *

Yes

If so, may we inquire at your present employer? *

Yes

Education: Please list institution, area of study and degree earned: *

I authorize investigation of any information provided on this application. I also authorize investigation of my employment record and references. I understand that any representation, falsification or omission is cause for voiding this application or termination of employment if hired. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated without cause at any time. I understand that the terms of this application cannot be changed or modified except by written agreement signed by an authorized representative of William H. Lane Incorporated. *

I agree