Employment Application

Please complete all required fields marked with an asterisk (*)

Personal Information

First Name *

Middle Name

Last Name *

Street Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

Employment Preferences

Employment Type *

Full Time Part Time Temporary

Position Applied For *

Available Start Date *

Desired Salary/Wage *

Part-time Hours/Days Available

Willing to Work: *

Evenings Overtime Weekends

Education

Highest Level of Education *

Grade School High School / GED Specialty / Vocational University

Course of Study / Major *

If you did not complete your education, please explain:

Skills

Additional Skills, Experience, or Qualifications

Employment History

May we contact your current employer? *

Yes No

Employer 1 (Most Recent) *

Company Name *

Phone Number

Address

Supervisor Name & Title

Position, Duties & Skills

From

Reason for Leaving

Employer 2 (Optional)

Company Name

Phone Number

Address

Supervisor Name & Title

Position, Duties & Skills

From

Reason for Leaving

Employer 3 (Optional)

Company Name

Phone Number

Address

Supervisor Name & Title

Position, Duties & Skills

From

Reason for Leaving

Personal References

Please provide three personal references (not relatives or former employers).

Reference 1 *

Full Name *

Phone Number *

Address *

Occupation *

Years Known *

Reference 2 *

Full Name *

Phone Number *

Address *

Occupation *

Years Known *

Reference 3 *

Full Name *

Phone Number *

Address *

Occupation *

Years Known *

Additional Information

Do you have any relatives or friends employed here? If so, please list:

Please explain any periods of unemployment longer than 3 months:

Have you ever been convicted of a crime? *

(A conviction will not necessarily disqualify you from employment.)

Yes No

Certification

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or termination, if employed. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I also understand that this application is not a contract of employment.

I have read and agree to the above certification statement. *

By clicking Submit, your application will be sent to Cajun Sugar LLC for review.

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