Have you ever been convicted of any misdemeanor or felony in the last seven years?
*
NOTE: Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense,
seriousness, and nature of the violation, and rehabilitation will be considered. (Do not include minor traffic citations and arrests or convictions,
which have been sealed or expunged.)
If hired, can you provide proof that you are over 18 years of age?
*
Are you capable of satisfactorily performing the essential job duties required for the position for which you are applying?
*
Do you have adequate transportation to and from work?
*
APPLICANTS STATEMENT & AGREEMENT
I acknowledge that, in order to be considered for employment, I must possess a valid driver's license and be at least 18 years old.
In the event that I am unable to secure immediate employment, I am aware that I may be contacted via email or phone call for potential future opportunities as suitable positions become available.
In the event of my employment to a position in the Company, I will comply with all rules and regulations
of this company. I understand that the Company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by the law. I also understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical
examination and related test to the Company. I also understand I may be required to take other tests such as personality and honesty tests, prior to employment and during my employment. I understand that should I decline to take any of the above test, my application for employment may be rejected or my employment be terminated. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed.
I understand that the company may investigate my driving record and my criminal record and that an
investigative consumer report may be prepared whereby information is obtained through personal interviews with my neighbors, friends, personal references, and others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode
of living. I understand that I have the right to make a written inquiry within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation. I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I herby fully waive any rights or
claims I have or may have against my former employers, their agents, employees and representatives, as well as other individuals who release of any such information by any person or party, whether such information is favorable or unfavorable to me. I authorize the persons named herein as personal
references to provide the Company with any pertinent information they may have regarding myself.
I also acknowledge that the Company utilizes a system of alternative dispute resolution that binding arbitration to resolve all disputes that may arise out of the employment context. Because of the mutual benefits (such as reduced expense and increased efficiency) which private binding arbitration can provide both the Company and myself, both the Company and I agree that any claim, dispute, and/or
controversy(including, but not limited to, any claims of discrimination and harassment, whether they be based on the Louisiana employment discrimination law, title VII of the civil rights act of 1964, as amended, as well as all other state or federal laws or regulations) that either I or the company (or its
owners, directors, officers, managers, employees, agents, and parties affiliated with its employee benefits and health plans) may have against the other which would otherwise require or allow resort to any court or other governmental dispute resolution forum arising from, related to, or having any relationship or connection whatsoever with my seeking employment with, employment by, or other
association with the Company, whether based on tort, contract, statutory, or equitable law, or otherwise, (with the sole exception of claims arising under the national labor relations act which are brought before the national labor relations board, claims for medical and disability benefits under workers compensation, and unemployment compensations claims filed with the state sh0all be submitted to and determined exclusively by binding arbitration under federal arbitration act, in
conformity with the procedures of the C>C 3099-3132, as am=d Act of 1985. However, in addition to
requirements imposed by law, any arbitration herein shall be a retired Louisiana judicial district court
judge and shall be subject to disqualifications on the same grounds as would apply to a judge of such
court. To the extent applicable in civil actions in the United States district courts, the following shall
apply and be observed: all rules of pleading , all rules of evidence, all rights to resolution of the dispute
by means of motions for summary judgment , judgment of pleadings. Resolution of the dispute shall be
based solely upon the law governing the claims and defenses pleaded, and the arbitrator may not
invoke any basis (including but not limited to, notions of “just cause”) other than such controlling law.
The arbitrator shall have the immunity of a judicial officer from civil liability when acting in the capacity
of an arbitrator, which immunity supplements any other existing immunity. Likewise, all
communications during or in connection with the arbitration proceedings are privileged. As reasonably
required to allow full use and benefit of this agreement, the arbitrator shall extend the times set for the
giving of notices and settling of hearings. Awards shall include the arbitrators written reasoned opinion
and at either party’s written request within 10 days after issuance of the award, shall be subject to
affirmation, reversal or modification, following review of the record and arguments of the parties by a
second arbitrator who shall as far as practicable, proceed according to the law and procedures
applicable to appellate unenforceable it shall be served and the remainder of this agreement shall be
enforceable.
I UNDERSTAND THAT BY VOLUNTARILY AGREEING TO THIS BINDING ARBITRATION PROVISION, BOTH I
AND THE COMPANY GIVE UP OUR RIGHTS TO TRIAL BY JURY OF ANY CLAIM I OR THE COMPANY MAY
HAVE AGAINST EACH OTHER.
I herby state that all the information that I provided on this application or any other documents filled
out in connection with my employment and in any interview is true and correct. I have withheld nothing
that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any
such information is later found to be false or incomplete in any respect, I may be dismissed.
If hired, I agree as follows: my employment and compensation is terminable at will, is for no definite
period, and my employment and compensation may be terminated by the Company (employer) at any
time and for any reason whatsoever, with or without good cause at the option of either the Company or
myself. No implied, oral, or written agreements contrary to the express language of this agreement are
valid unless they are in writing and signed by the president of the Company (or majority owner or
owners if Company is not a corporation), no supervisor or representative of the Company, other than
the president of the company (or majority owner or owners if company is not a corporation), has any
authority to make any agreements contrary to foregoing. This agreement is the entire agreement
between the Company and the employee regarding the rights of the company or employee to terminate
employment with or without good cause, and this agreement takes place of all prior and
contemporaneous agreements, representations, and understanding of the employee and the company.
If you have any questions regarding this statement, please ask a company representative before singing.
I herby acknowledge that I have read the above statements and understand the same.
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF THIRTY (30) DAYS. IF YOU
WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS
TRUE AND ACCURATE.
