APPLICATION FOR OFFICE

1. Thank you for your interest in joining our team at LeFebvre Companies. Please take the time to thoroughly complete the application below and submit to be considered for employment.

   If you experience any issues please contact us so we may assist you.

   As an additional option to apply, you may also print this page and submit the application to us in the following methods:

   • Send Online: Print form, complete, and scan the application. Then return to this page, fill in only the required fields and attach the form to the document section of the online application then submit
   • Fax: Print form, complete, and fax application to 612-252-4699
   • Mail: Print form, complete, and mail application to LeFebvre Companies 10895 171st Ave NW Elk River, MN 55330

1. THIS APPLICATION IS NOT AN EMPLOYMENT AGREEMENT but is merely intended to evaluate suitability as an employee. It is the policy of the company to provide an equal opportunity to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before an employment offer is made. If an employment offer is made, the offer may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
2. First Name(*)
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3. Middle Name
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4. Last Name(*)
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5. Email Address(*)
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6. Phone Number(*)
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7. Current Address
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8. Current City
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9. Current State
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10. Current Zipcode
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1. HIGH SCHOOL
2. School
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3. City
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4. State
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5. Diploma
   YesNoInvalid Input

1. UNDERGRAD SCHOOL
2. School
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3. City
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4. State
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5. Diploma
   YesNoInvalid Input
6. Degree
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7. Area of Study
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1. OTHER SCHOOL
2. School
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3. City
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4. State
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5. Diploma
   YesNoInvalid Input
6. Degree
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7. Area of Study
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1. Have you completed any special courses, seminars and/or training that would enable you to perform the positions which you are applying for?
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2. List academic honors, extracurricular activities, offices held, etc. in high school or college
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   (Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)

1. EMPLOYMENT INFORMATION
2. Position Applied For
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3. Can you perform the essential functions of the position for which you are applying for?
   YesNoInvalid Input
4. If "NO", Please Explain
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   (If you have questions as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer the question.)
5. Date You Can Start
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6. Are you at least 18 years of age and legally eligible to work for our company in the United States?
   NoYesInvalid Input
7. If you are under 18 years of age, can you provide required proof of your eligibility to work?
   NoYesInvalid Input
8. Have you ever worked under another name? List Name(s) and Reason for change.
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9. Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years?
   NoYesInvalid Input
10. If yes, please explain...
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11. Have you worked for LeFebvre Companies before?
    NoYesInvalid Input
12. If yes, please provide dates and locations. Also include Reason for Leaving.
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13. Do any of your friends or relatives, other than spouse, work here?
    NoYesInvalid Input
14. If yes, state name and relationship...
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15. Have you ever done any volunteer work?
    NoYesInvalid Input
16. If yes, please explain...
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    (Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)
17. Do you belong to any professional, trade, business, or civic organizations that deal with the position for which you are applying?
    NoYesInvalid Input
18. If yes, please explain...
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    (Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)
19. Do You Prefer
    Full-TimePart-TimeEitherInvalid Input
20. Can you work
    WeekendsEveningsInvalid Input
21. Available
    MTuWThFSaSuInvalid Input
22. Employment History

    Give a Complete Record of all employment for the past three years, including any unemployment or self-employment.
23. Are you currently employed?
    NoYesInvalid Input
24. May we contact your present employer?
    NoYesInvalid Input

1. MOST RECENT EMPLOYER
2. Employer
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3. City
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4. State
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5. Phone
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6. Position Held
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7. From (Mo/Yr)
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8. To (Mo/Yr)
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9. Pay upon leaving
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10. Supervisor
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11. Duties
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12. Reason For Leaving
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1. PRIOR EMPLOYER 01
2. Employer
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3. City
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4. State
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5. Phone
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6. Position Held
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7. From (Mo/Yr)
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8. To (Mo/Yr)
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9. Pay upon leaving
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10. Supervisor
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11. Duties
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12. Reason For Leaving
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1. PRIOR EMPLOYER 02
2. Employer
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3. City
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4. State
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5. Phone
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6. Position Held
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7. From (Mo/Yr)
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8. To (Mo/Yr)
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9. Pay upon leaving
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10. Supervisor
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11. Duties
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12. Reason For Leaving
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1. PRIOR EMPLOYER 03
2. Employer
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3. City
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4. State
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5. Phone
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6. Position Held
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7. From (Mo/Yr)
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8. To (Mo/Yr)
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9. Pay upon leaving
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10. Supervisor
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11. Duties
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12. Reason For Leaving
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1. Have you ever been convicted of a felony?
   NoYesInvalid Input
2. Please use this space to list any special skills you may have that relate to the position applied for
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3. Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.
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4. Account for any full months since leaving school (high school/college) that you were not working.
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   Include Dates and Reason

1. REFERENCE 01
2. Name
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3. Address
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4. Phone
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5. Relationship
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6. Years Acquainted
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1. REFERENCE 02
2. Name
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3. Address
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4. Phone
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5. Relationship
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6. Years Acquainted
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1. REFERENCE 03
2. Name
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3. Address
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4. Phone
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5. Relationship
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6. Years Acquainted
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1. Upload File
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   Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)

1. APPLICATION AGREEMENT

   I have read and reviewed the information provided in this application and the above statements. By signing this application for qualification, I certify that I understand all parts of it and have answered all questions completely and fully.

   I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding agreement.
2. Type Name in Signature Box(*)
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