Goldstein Lewin & Co. is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

Personal/Contact Information
First Name:
Last Name:
Street Address:
Apartment or Suite #:
Town/City:
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Zip:
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Position Sought:	Full time   Part time   Internship
Date available for employment:	/ (mm/yyyy)
Authorized to work in US	Yes   No
Education
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Field of Study
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Professional License or Membership (You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.)
Type of License(s) held
State of Issuance
Institution
Level of Membership
Employment
Annual Base Compensation
Annual Total Compensation
Current Employer	(enter none if not currently employed)
Current Job Title	(enter none if not currently employed)
Previous Employer
Previous Job Title
Attach Resume
Affirmation By completing this application, I certify that the information provided and the accompanying resume is true and complete to the best of my knowledge. I authorize Goldstein Lewin & Co. to verify their accuracy and to obtain reference information on my work performance. I understand that falsified statements of any kind or omissions of facts may disqualify me for consideration for this position and may lead to dismissal from employment if discovered at a later date. List exceptions, if any, prior to submission:
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