Lookout Mountain Community Services Dedicated to health, healing, and recovery

Full Employment Application

LMCS Application for Employment

This employment application must be fully completed in order to be considered for employment.  You will also certify that all information contained in this application is correct and authorize any agent or employee of LMCS to verify this information and to release it to anyone who may consider me for appointment.  You understand that intentionally providing false information on this form or attachments is a violation of state law, and also understand that applications submitted electronically, via e-mail or similar media, are not valid unless you enter your name in the designated signature field below and such action shall constitute an electronic signature.

If you are unable to complete the online application you may download the Employment Application in Adobe format (.pdf).  Once completed, you can either submit in person at 501 Mize Street in Lafayette, or send by electronic mail to jobs@lmcs.org

In order that LMCS can better evaluate your qualifications, you will give permission for LMCS to investigate all references and to secure Reference Check information about me in order to arrive at a hiring decision. You also authorize all persons, institutions, organizations and companies to furnish any and all information sought and I waive any legal requirement to provide notice to me regarding reports, records or information given or received in accordance with this authorization.  By agreeing, you hereby release and hold harmless LMCS, its agents, employees, and assigns from any claim of liability you may have against it and /or them for decisions, even if adverse, arising out of information received in response to the Reference Check.  You authorize any person or entity to whom this Reference Check is presented to release any information required therein to LMCS, its agents, employees, or assigns. You further agree to hold harmless any person or entity from any claims of liability you may have against him/her/it for the release of such information, and waive and release any such claims.

If an employment offer is extended you may be required to complete a pre-employment drug test.  You are advised that if you are offered employment the offer will be withdrawn and you disqualified from employment for a period of two (2) years from the date of testing or refusal to test if you:

  • expressly decline to submit to testing;  fail to appear for drug testing as directed; engage in conduct that clearly abstracts the testing process;
  • fail to provide, adequate urine for drug testing without a valid medical explanation: provide a urine sample determined by the testing laboratory to have been adulterated;
  • or, test positive for the use of an illegal drug(s).

Street Address


City

State

Zip
EQUAL EMPLOYMENT OPPORTUNITY MONITORING INFORMATION
-
(###)
-
###

####
-
(###)
-
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Native American
Hispanic
Asian/Pacific Islander
White
not of Hispanic Origin
Black
not of Hispanic Origin
Multi-Racial
Male
Female
Yes
No
EMPLOYMENT ELIGIBILITY
Yes
No
Yes
No
N/A
Yes
No
TYPE OF WORK SOUGHT
Mental Health
Developmentally Disabled
Substance Abuse
Adult C&A
Clerical
Full-Time
Part-Time
Temporary
Flexible
Any
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Bartow
Catoosa
Chattooga
Dade
Fannin
Floyd
Gilmer
Gordon
Haralson
Murray
Paulding
Pickens
Polk
Walker
Whitfield
Yes
No
Supervised Other Staff
Typing
Data Entry
Multilingual
Car for use at work
Managed a Department
Will work night shifts
Sign language
Advanced Computer Skills
Entry-Level Computer Skills
Writing Skills
Reading Skills
Accounting Skills
WORK HISTORY (THE LAST 10 YEARS OF EMPLOYMENT MUST BE INCLUDED)

Street Address


City

State

Zip
Yes
No
-
(###)
-
###

####

Street Address


City

State

Zip
Yes
No
-
(###)
-
###

####
WORK REFERENCES - LIST AT LEAST THREE (3) PROFESSIONAL WORK REFERENCES

Street Address


City

State

Zip
-
(###)
-
###

####

Street Address


City

State

Zip
-
(###)
-
###

####

Street Address


City

State

Zip
-
(###)
-
###

####
FORMAL EDUCATION
Yes
No
LIST EXACT COLLEGE INFORMATION BELOW (Start with last school first)
CERTIFICATION
AUTHORIZATION FOR RELEASE REFERENCE INFORMATION
Yes
No
Yes
No


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