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10709 S. Walton Road, La Grande, OR 97850

Call Us Today (541) 962-7753 Request Appointment Online
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Application form

MM slash DD slash YYYY
Name
Check time willing to work

Education

Did you graduate?
Did you graduate?
Did you graduate?
Did you graduate?
Did you graduate?

Professional Information (if applicable)

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Employment History (Start with most recent employer-Please also include your last name while employed with that company)

Address
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MM slash DD slash YYYY
Name of Supervisor
May we contact them?

Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Name of Supervisor
May we contact them?

References - Please list three professional references and one personal reference.

Full Name
Address

Full Name
Address

Full Name
Address
I attest with my signature below that I have given to [Company Name] true and complete information on this application. No requested information has been concealed. I also understand that [Company Name] may request to contact references provided for employment reference checks, and under consistent hiring practices, may require pre-employment screening and background verification as a condition of employment upon any employment offer. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.
MM slash DD slash YYYY

Pre-Interview Information

Complete the following information in your own handwriting.
x

We want to thank everyone for their patience during this unusual time. We have now opened for our normal hours to serve all eye care needs. We do ask that you wear a mask when you enter our building. Unless you are a parent of a child or a caretaker, we are also asking you to leave friends and family at home or in the car unless they have business in the building as well. In an effort to keep physical distance guidelines, you may be asked to wait in your car for a phone call. Thanks again for your patience, and we look forward to serving you.

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