LeTache Employment Application • Apply • General Information

Where did you hear about us?

You must select one.

If you selected Other above, please enter your response here.

You must enter where you heard about us.

Social Security/Tax ID Number

You must enter your social security / tax id number (numbers only, no spaces/dashes).

First Name

You must enter your first name.

Last Name

You must enter your last name.

address

You must enter your address.

City

You must enter your city.

State

You must select your state.

Zip (5 digits only)

You must enter your zip code (5 digits only, no zip+4).

Phone Number

You must enter your phone number (numbers only, no spaces/dashes).

I constent to receive SMS messages at the above phone number in relation to my employment application:

You must select whether or not you agree.

E-Mail Address

You must enter your email address.

Are you over 18 years of age?

You must select whether you are over 18 years of age.

Date of Birth

You must select a month.

You must select a day.

You must select a year.

Do you have your own vehicle?

You must select whether you have your own vehicle.

I understand and agree that this is a smoke free work environment and I will not smoke while at work.

You must agree to the smoking policy.

Have you been on unemployment in the last 2 years?

You must select whether you were on unemployment in the last 2 years.