Fast and hard worker and dependable
Resume:
Teche Bottling & Distribution
New Iberia, LA 70560
****@*************.***
Employment Application
Applicant Information
Full Name:
Date:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
ZIP Code
Phone:
Date Available:
Social Security No.:
Desired Hourly Pay:
$
Position Applied for:
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Do you speak any foreign language(s) fluently?
YES
NO
If yes, specify:
Have you ever worked for this company?
YES
NO
If yes, when?
Do you have a valid Driver’s License?
YES
NO
License No.
Is it a CDL Driver’s License? If Yes, state Class and Endorsement Information:
State Issued
Date Issued
Expiration Date
Have you ever been convicted of a felony?
YES
NO
*Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense.
If yes, explain:
Education
High School:
From:
To:
Did you graduate?
YES
NO
Diploma:
College:
From:
To:
Did you graduate?
YES
NO
Degree:
Other:
From:
To:
Did you graduate?
YES
NO
Degree:
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
References
Please list three professional references (no relatives).
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
Full Name:
Relationship:
Company:
Phone:
Military Service
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Equal Opportunity Employer Statement
Teche Bottling & Distribution is proud to be an Equal Opportunity Employer committed to inclusion and diversity. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, gender expression, age, Veteran status, disability, genetic information, political views or activity, or other legally protected characteristics. Teche Bottling & Distribution will consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. We are also committed to providing reasonable accommodations for qualified individuals with disabilities.
Annex D. Applicant Consent and Release Form
In consideration of me being considered for employment by Teche Bottling & Distribution, I give my consent to, and authorize MEDXCEL to perform testing or medical procedures necessary to determine the presence and/or level of alcohol and drugs in my body. I further give my consent to release to Teche Bottling & Distribution or its designated agents, the results of any medical tests performed by the above named providers, including any tests or medical procedures to determine the level and/or presence of alcohol or drugs in my body. I realize that my refusal to sign this form constitutes a violation of the stated policy of Teche Bottling & Distribution, and for that refusal, I will not be considered for, and knowingly waive any possibility for employment with the Company. I understand that this consent and release shall be valid for the length of my employment with Teche Bottling & Distribution.
Affidavit
I certify that the answers given by me in the foregoing questions are true and correct without consequential omissions of any kind whatsoever. I agree that Teche Bottling & Distribution shall not be liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this questionnaire. I authorize the companies, schools, or persons named above to give any information regarding my employment, together with any other information they have regarding me whether or not it is in their records. I hereby release said companies, schools, or persons from all liability for any damage for issuing this information. I also understand that any offer of employment will be conditioned on results of a pre-employment drug screen, background check, and driver's license check.
Background & Driving Record Check
I am applying for a position with Teche Bottling & Distribution; therefore, hereby authorize the Iberia Parish Sheriff’s Office or another organization designated by Teche Bottling & Distribution to perform a background check, which includes a driving record check, as part of my application of employment with Teche Bottling & Distribution. I authorize the Iberia Parish Sheriff’s Office or another organization designated by Teche Bottling & Distribution to release the information regarding the background check and driving record check to Teche Bottling & Distribution. I understand that this information is used for this purpose only and will not be used in discrimination purposes.
Post Offer
Post offer criteria are stated at the top of this page known as “Annex D.”
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Applicant Signature:
Print Name:
Date Completed:
Contact this candidate