Employment Application La Tana, LLC is an Equal Opportunity Employer and will not discriminate in the hiring process on the basis of age, sex, religion, national origin or handicap. Email Applicant Information Last Name * First Name * Mid. Initial Street Address * Apt/Unit # City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone * Email Address Date Available Social Security No. Desired Salary Position Applied for Are you a citizen of the United States? * Yes No Have you ever worked for this company? * Yes No Have you ever been convicted of a felony? * Yes No Education High School College Other References Full Name Full Name Previous Employment Company Company Company Military Service Branch Disclaimer and Signature By entering my full name as an electronic signature below I declare that I have read or have been read the above content, and I certify that all of my answers on this employment application are true and correct. I understand that false statements on this application will be considered sufficient cause for dismissal if employed. I authorize the employer to contact and obtain information about me from previous employers, schools and “references” and any other party necessary to verify the accuracy of information disclosed in this application, an employment resume or personal interview. Upon request, I agree to sign any other releases required for matters covered herein. Signature * Date * Information Summary