The Shack - Houma, LA | Employment Application

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Employment Application

Name *

First

Middle

Last

Address *

Address (Apartment/Unit)

City *

State *

Zip Code *

Phone *

Are you 18 years or older? *

Yes
No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? *

Yes
No

Position Desired *

Date You Can Start *

Salary Desired *

Are you employed now? *

Yes
No

If so, may we inquire of your present employer? *

Yes
No

Ever applied to this company before? *

Yes
No

When?

Referred By

Grammar School (Name & Location) *

Number of Years Attended *

Did you graduate? *

Yes
No

High School (Name & Location) *

Number of Years Attended *

Did you graduate? *

Yes
No

College (Name & Location)

Number of Years Attended

Subjects Studied

Trade, Business or Correspondence School

Number of Years Attended

Subjects Studied

Did you graduate?

Yes
No

Subjects of Special Study or Research Work

Special Skills

Activities (Civic, Athletic, etc...)

Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.

U.S. Military or Naval Service

Rank

Present Membership in National Guard Reserves

Former Employer #1 *

Address *

Salary *

Position *

Reason for Leaving *

Former Employer #2

Address

Salary

Position

Reason for Leaving

Former Employer #3

Address

Salary

Position

Reason for Leaving

Which of these jobs did you like best? *

What did you like most about this job? *

Reference #1 *

Relationship *

Address *

Phone *

Years Acquainted *

Reference #2

Relationship

Address

Phone

Years Acquainted

Reference #3

Relationship

Address

Phone

Years Acquainted

Emergency Contact *

Address

Phone *

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 may 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 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 its President, and then only when in writing and signed by the President, 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. *

I certify and agree