PRE-EMPLOYMENT APPLICATION

Our company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the American's With Disabilities Act.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

P.O. Box 790
LACOMBE, LA 70445
OFFICE (985) 882-6101
FAX (985) 882-6183

PERSONAL

Have you ever been convicted of any crime (excluding minor traffic violations) including


EMPLOYMENT DESIRED


MILITARY

 


EDUCATION

High School From:
To:
Graduate
Diploma
College From:
To:
Graduate
Degree
Trade School From:
To:
Graduate
Diploma



CAPABILITY / RELIABILITY


WORK HISTORY

List names of employers in consecutive order with present or last employer first. Account for all periods of time, including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Employer Contact
Employer Contact Number
DATES EMPLOYED
From: To:
Month: Month:
Year : Year :
Pay
Start:
Ending:
NATURE OF BUSINESS TITLE / POSITION
NAME AND TITLE OF LAST SUPERVISOR REASON FOR LEAVING

EMPLOYER CONTACT EMPLOYER CONTACT NUMBER DATES EMPLOYED
From: To:
Month: Month:
Year : Year :
Pay
Start:
Ending:
NATURE OF BUSINES TITLE/POSITION
NAME AND TITLE OF LAST SUPERVISOR REASON FOR LEAVING

Employer Contact
Employer Contact Number
DATES EMPLOYED
From: To:
Month: Month:
Year : Year :
Pay
Start:
Ending:
NATURE OF BUSINESS TITLE / POSITION
NAME AND TITLE OF LAST SUPERVISOR REASON FOR LEAVING

SUPPLEMENTAL EMPLOYMENT INFORMATION:


SPECIAL SKILLS:


REFERENCES

NAME



ADDRESS



PHONE



OCCUPATION




AUTHORIZATION TO OBTAIN INFORMATIONPRIVACY ACT STATEMENT AND RELEASE

To Whom It May Concern:
This authorization and release, or photocopy hereof, is unlimited as to time.I authorize and release you to furnish any and all information to Python Corporation; P.O. Box 790; Lacombe, LA 70445 and/or their agents. Regarding my character, health, wealth, finances, civil and criminal suits, credit, medical records, birth records, state and federal records, accident reports, personal records, pre-employment records and/or any other information that might be necessary for Python Corporation and/or their agents to complete their investigation.




AFFIDAVIT

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize the Company to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements.

I agree that, if I am employed, I will abide by all the rules and regulations of the company. I understand that the taking of drug and alcohol testes, when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that nobody in the company is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the President of the Company. I also understand that my employment is “at-will” and may be terminated by myself or by the company at any time for any reason at all, with or without prior notice.



*

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