Personal

Full Name
 Date of Birth
Present Address
City
 State
 Zip
Phone
 Cell Phone
 Social Security Number


Position Applying For:
 Years Experience:
Select One:
Salary Desired:
 Date You Can Start:
Are You Employed Now?
 If So, Where?
Supervisor's Name:
 May We Contact Them?
Do You Have a High School Diploma?

Education

Name and Address of School Major Degree/Diploma Graduation Date

Skills and Qualifications: Licenses, Skills, Training, Etc.

Employment History

List below the last four employers, starting with the most recent.

Date/Month/Year Name and Address of Employer Position/Duties
From
 Employer1 Name
 Duties/Position
To
 Employer1 Address
 Starting Salary
 Ending Salary
 Reason for Leaving
From
 Employer2 Name
 Duties/Position
To
 Employer2 Address
 Starting Salary
 Ending Salary
 Reason for Leaving
From
 Employer3 Name
 Duties/Position
To
 Employer3 Address
 Starting Salary
 Ending Salary
 Reason for Leaving
From
 Employer4 Name
 Duties/Position
To
 Employer4 Address
 Starting Salary
 Ending Salary
 Reason for Leaving
 

References

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

Name Phone Business Name Address


Are there any health problems or other reasons that will:
1.) Result in absence from work?
If yes, please explain:
2.) Prevent lifting or any other specific job duties?
If yes, please explain:
3.) Cause a problem with 24 hour service?
If yes, please explain:

Are you taking any type of medication, if so please list and explain why:
Do you have a current Louisiana Drivers License,if so what class:
Are there any restrictions on your Drivers License, if so please explain:
Do you have your own transportation, if not how do you plan to get to work:

Have you ever been ticketed for: (if so please explain in detail)
1.) DWI: 
1.) Reckless Operation:
1.) Speeding:
1.) Other, please list:
Have you ever been convicted of a felony?
If so are you now on probation: (please give details)
Are there any pending or previous lawsuits with previous employers, if so please list and explain

Cajun Cutters, Inc. most values those employees who work safe, learn fast, and maintain a positive attitude. All prospective employees must pass a physical and drug screen prior to joining our team. In addition, all employees are subject to randomly administered drug testing.

I authorize Cajun Cutters, Inc. to investigate any and all statement contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, reguardless of the date of payment of my wages and salary, be terminated at any time, without any previous notice.

I hereby authorize Cajun Cutters, Inc. permission to investigate any present records, including records from previous employers, state, and federal agencies.

NOTE: PLEASE READ BEFORE SUBMITTING.
IF YOU ARE TERMINATED, OR YOU QUIT WITHIN THIRTY WORKING DAYS OF YOUR HIRE DATE, A FEE OF $125.00 DOLLARS WILL BE DEDUCTED FROM YOUR CHECK FOR YOUR DRUG SCREEN AND PHYSICAL.

  Accept Terms
 Date: