Keokuk, IA - Application - TLC Associates

Application for Employment

If you would like to be considered for employment, please fill out the application below. We will be in touch once we have your completed application on file.

Full Name(Required)

First Middle Last

Email(Required)

Primary Phone Number(Required)

Available Start Date(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please Attach Your Cover Letter Here:

Max. file size: 2 GB.

Please Attach Your Resume Here:

Max. file size: 2 GB.

Employment History

Please provide information on your most recent employer. If you have no employment history, simply enter “not applicable”.

Title

Company Name

City, State

Start Date of Employment (month and year)

Last Date of Employment (month and year)

Reason for leaving

May we contact this employer?

Yes

Second Most Recent Employer (NOTE: If you do not have any other employers to list, you may skip this page.)

Title

Company Name

City, State

Start Date of Employment (month and year)

Last Date of Employment (month and year)

Reason for leaving

May we contact this employer?

Yes

Next Most Recent Employer: (NOTE: If you do not have any other employers to list, you may skip this page.)

Title

Company Name

City, State

Start Date of Employment (month and year)

Last Date of Employment (month and year)

Reason for leaving

May we contact this employer?

Yes

Candidate Screening

Please answer the following screening information:

Are you looking for Full or Part-time employment?(Required)

Full-TIme

Part-Time

Are you 18 years of age or older?(Required)

YES

Have you ever been employed at TLCA, either as a permanent employee or on a temporary basis through a staffing agency?(Required)

YES

If you are not a US citizen, does your visa or immigration status permit lawful employment?(Required)

YES

Please list the highest level of education that you have completed and/or any military experience.(Required)

Please select your referral source

Facebook Job-Ad

Instagram Job-Ad

Online Ad

TLCA Website

Indeed

Current Employee Referral

If Current Employee Referral :

Please Spell Out Full Name & position

Sign and Date

IMPORTANT:PLEASE READ THE FOLLOWING AND SIGN/DATE

It is understood and agreed upon that any misrepresentation by me in the application or subsequent interview process will be sufficient cause for cancellation of this application and/or separation from the employer’s services if I have been employed. Furthermore, the electronic signature below authorizes the employer to conduct background checks related to any arrests or convictions that are a matter of public record. I give the employer the right to investigate all references and to secure additional job related information about me. I hereby release from any liability the employer and its representatives to seek such information and all other persons, corporations or organizations for furnishing such information.

TLC & Associates is an Equal Opportunity Employer, and as such does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on any basis prohibited by local, state, or federal law.

By indicating “yes” below, I acknowledge that I accept and agree to the terms of the employment statement above.

I accept and agree to the terms of the employment statement above:

Full Name (Note: this will serve as your electronic signature)(Required)

Please date your application. (Note: application date must be entered to be considered valid.)(Required)

Date

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Keokuk, IA – Application

Application for Employment

Employment History

Candidate Screening

Voluntary Information

Definitions of race/ethnic categories

Sign and Date

IMPORTANT:PLEASE READ THE FOLLOWING AND SIGN/DATE

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