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Online Employment Application

Simply fill this out in your browser, print it, sign it and either mail it, fax it or bring it by one of our offices. This is your first step in joining the TLCCS Family.

Please complete all questions

Demographic Information
Last Name: First Name: Middle Initial: Social Security:
Address:
City: State: Zip Code:
Home Phone: Business Phone:
In Case of Emergency, Notify:
Name:   Address:
Relationship:   Phone:
How Were You Referred to TLCCS?
Have You Worked for TLCCS Before?   If Yes, When?: to
Position Applied For? Type of Employment: Date of Availability:
Salary Expected: Hours Pref: Location:

Please list all employment beginning with your last employer first. Account for all periods of unemployment.

Employer Title and Duties  
Name:

Address:

Phone:

Supervisor's Name:
  
 Employed From - Employed To
-

Start Salary - End Salary:
-

May We Contact Your Employer?

Reason for Leaving:

Employer Title and Duties  
Name:

Address:

Phone:

Supervisor's Name:
  
 Employed From - Employed To
-

Start Salary - End Salary:
-

May We Contact Your Employer?

Reason for Leaving:

Employer Title and Duties  
Name:

Address:

Phone:

Supervisor's Name:
  
 Employed From - Employed To
-

Start Salary - End Salary:
-

May We Contact Your Employer?

Reason for Leaving:

Employer Title and Duties  
Name:

Address:

Phone:

Supervisor's Name:
  
 Employed From - Employed To
-

Start Salary - End Salary:
-

May We Contact Your Employer?

Reason for Leaving:


References
Professional Reference Name: Personal Reference Name:
Phone Number: Phone Number:
Address: Address:

Education
Grade or High School
 Dates Attended
- 		Highest Grade Completed
 Diploma/Degree
College
 Dates Attended
- 		Highest Grade Completed
 Diploma/Degree
Graduate School
 Dates Attended
- 		Highest Grade Completed
 Diploma/Degree
Vocational or Other Training
 Dates Attended
- 		Highest Grade Completed
 Diploma/Degree

Skills
Typing WPM:   Other Skills or Qualifications (Office Machines, Professional Registration, Certification or Licensure):
Shorthand WPM:
Dictating Machine:
US Military Service: If Yes, Date of Entrance:     Date of Discharge:
Describe Your Duties:
Are You Under 18 Years of Age?  
Are You a US Citizen? If not a US Citizen, give Visa Class, Number and Expiration Date:
Do you have any physical limitations, which prevent you from performing certain kinds of work?
  If yes, list and describe specific work limitations:
Have you ever been convicted for any reason other than a minor traffic violation?
  If yes, explain and give dates:
  
Are you related to any TLCCS employee(s) by blood or marriage?
  If yes, give their name(s):   

Please read the following:

  1. Under the Maryland law, an employer may not require or demand any applicant for employement or prospective employment or employee to submit to or take a polygraph, lie detector test or similar test or examination as a condition of employment of continued employment. Any employee who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.
  2. I certify that to the best of my knowledge, this information is true and I understand that any misrepresenation or willful omission of facts may be cause for immediate dismissal.
  3. I understand that this application will remain active for six months. I must renew this application after six months to be considered for any vacant positions
  4. I consent to verification of my employment history and give permission to contact references listed.

By clicking on the NEXT button below you are not submitting any information that will be stored on TLCCS's computer systems. What you will see is a printable version of this application with all of your answers. After you have finished this form please do either of the following:

  1. Print out the form and sign it; it is not a valid application without a signature.
  2. Either bring it to our office in Princess Anne, MD or mail it to us.

If you've found that you have made a mistake just click on the "Back" button on your browser, fix the mistakes and press NEXT again. No information is submitted to our system.

End of Application: Please click on the SUBMIT button to receive printable version of this application. If you have a resume please send it along with this application.

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