Larry Moore Productions

Online Application

Please fill in the form below. Fields marked with an asterisk (*) are optional. After we receive your application, we will contact you regarding an interview.

PRE-EMPLOYMENT APPLICATION			Date You Can Begin
Full Name			Birthdate
Street Address (local)			City, State, Zip
Local Phone			E-Mail
*Soc. Sec. Number			Driver's License
Have you ever been convicted of a criminal offense?			No — Yes
Have you ever been convicted of a traffic violation?			No — Yes

Work Experience Include militay service, if any. List last job first
Name		Phone
Address		City, State, Zip
Dates Employed From:	to:
Position		Salary
Supervisor		Reason For Leaving
May we contact this employer? No — Yes
*Name		*Phone
*Address		*City, State, Zip
*Dates Employed From:	to:
*Position		*Salary
*Supervisor		*Reason For Leaving
*May we contact this employer? No — Yes
*Name		*Phone
*Address		*City, State, Zip
*Dates Employed From:	to:
*Position		*Salary
*Supervisor		*Reason For Leaving
*May we contact this employer? No — Yes

Please specify days and times you are available to work.
SUN	MON	TUE	WED
THU	FRI	SAT
The job for which you are applying may require you to work late nights, Saturdays, Sundays, holidays and term breaks. Are you willing to work such a schedule? No — Yes
How long do you plan on being in the State College area?

Personal References (those you have known at least one (1) year — do not include relatives)
	Name & Position	Address	Phone with area code
1.
2.
3.

Education
High School		Did you graduate? No — Yes
College		Did you graduate? No — Yes
Other		Did you graduate? No — Yes
Are you in school now? No — Full-Time — Part-Time # Credits

BY ENTERING YOU INITIALS HERE, YOU CERTIFY THAT THE INFORMATION GIVEN IN THIS FORM IS ACCURATE AND COMPLETE. YOU UNDERSTAND THAT ANY MISREPRESENTATION IN THIS APPLICATION AND THE INFORMATION CONTAINED THEREIN MAY CONSTITUTE GROUNDS FOR DISMISSAL.