Let's Talk
Corporate Office 280-a Equity Blvd. Houma, LA 70360 985-851-2330
EMPLOYEE APPLICATION
General Info
Programs, services and employment are equally available to everyone. Please inform the Human Resources department if you require reasonable accommodation for the application or interview. Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical
Position Applied for:
How were you referred to us?
Name
Present Address
Phone
Email
Date Available to Start
Salary Requirment
If you are under 18 years of age, can you provide a work permit?
*This Field is Required
Have you ever worked for this company?
Are you legally allowed to work in the United States?
Type of employment desired:
Have you ever pleaded guilty, no contest or been convicted of a crime?
Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Driver's license number (if applicable to position)
State
Education
Name & Location of High School
Name & location of College
Did you graduate?
Trade, Business or Correspondence School
Summarize Your Special Skills or Qualifications
Employment Desired
Dates of Employment
Address
Starting Salary and Title
Ending Salary and Title
Reason for Leaving
May we contact this employer for a reference?
*Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability related or medial information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws." Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical.
Signature of Applicant
Date