Overview » Opportunities » Part-time » Application
First Name
Middle Name
Last Name
Social Security Number(for security reasons, please enteryour last 4 digits only) XXX-XX-
No
Yes
If yes, name:
Street
City
State
Zip Code
Phone Number
Email Address
(If under 18 years of age, employmentis subject to verification ofminimum legal age by a work permit.)
Dodgeville Stevens Point Reedsburg Not Applicable
Not Applicable Dodgeville, WI Oshkosh, WI Madison, WI (Prairie Towne) Madison, WI (State Street) Brookfield, WI Fox Point, WI Har Mar, MN Minnetonka, MN Richfield, MN Woodbury, MN Niles, IL Schaumburg, IL Lombard, IL Rochester, NY
Position
First Second Third Any
If yes, language(s)
Date you can start
Salary desired - $.00
If yes, what location?
When
1 2 3 4 5 6 7 8 9 10 11 12
High School name/location
(College or university, nursing school, business college, or other schools you have attended)
Name of Institution
Location
From
To
Major
Degree conferred and year
(The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are age 40 and older.)
Describe any education and training you have received which is not covered above, such as vocational school, correspondence courses, service schools, in-service training, or volunteer work which you feel is relevant to the job you are applying for. Also include relevant licenses or certificates. Be specific and include dates.
Please list below your last 3 employers, starting with the most recent one.
Employer
Name of Supervisor
Address
Pay - $.00
Reason for leaving
Lands' End employee's name
Lands' End employee's dept.
Newspaper
Radio ad
Technical college/university
Other
I understand that I may be required to successfully complete a drug screen.
Name
Date:
month january february march april may june july august september october november december day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 30 26 27 28 29 30 31 year 2009 2010 2011 2012
This form has been designed to strictly comply with state and federal fair employment practice laws prohibiting employment discrimination. Lands' End is an equal opportunity employer and does not discriminate against applicants on the basis of race, color, sex, religion, national origin, handicap, veteran status, age, sexual orientation, marital status, or any other protected category as required by law.
Various agencies of the United States Government require employers to maintain information on applicants pertaining to factors such as race and sex. The information requested is for the purpose of our compliance with those record keeping requirements and to determine recruiting and employment patterns. Lands' End believes all persons are entitled to equal employment opportunities and does not discriminate against its employees or applicants on the basis of race, color, sex, religion, national origin, handicap, veteran status, age or marital status.
White
Black
Hispanic
Asian or Pacific Islander
American Indian or Alaska native
Other:
female
male
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