3185 Balis Drive, Suite 114
Baton Rouge, Louisiana 70808
225.315.1082
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Employment Application

  • Personal Information

  • Employment Desired

  • Education

  • General

  • This form has been revised to comply with the provisions of the Americans with Disabilites Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

  • Former Employers (List below last three employers, starting with the most recent)

  • Employer 1

  • Employer 2

  • Employer 3

  • References (Give the names of three persons not related to you, whom you have known at least one year.)

  • Reference #1:

  • Reference #2:

  • Reference #3:

  • In Case of an Emergency

  • I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY AT -WILL EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S OWNER, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE OWNER, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.
  • Date Format: MM slash DD slash YYYY
  • This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.