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Crescent City Foods Corp. ®

West Monroe, LA

*Required Information
  GENERAL APPLICANT INFORMATION
First Name*
 Middle
 Last Name*
 Social Security Number*
- - 		Email Address
Street Address*

 Apt.
 City*
 State*
 Zip*
 Home Phone Number*
- -
Drivers License State
 Drivers License Number
 Cell Phone Number*
- -  
Position you are applying for
Hourly Wage Requested
Date available for work Referred by Do you have transportation to work?
  Are you 18 or older?*
  What is your birth date?  
Are you legally authorized to work in the United States?*
Do you have a relative employed by Crescent City Foods Corp?

If yes, who?
 Have you ever been employed by Crescent City Foods Corp. before?*
 If so, when and where last employed?
   Position held:
Hours / Days Available
  From Until
Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

Sunday*
Please enter the total number of hours per week you are available to work* 
  EDUCATION
 School Name, City and State Did you
graduate?
( Yes / No )		 Degree/Courses G.P.A.
 High School
  		     
 College
  		     
 Graduate School
  		      
 Other
  		     
  EMPLOYMENT BACKGROUND (most recent first)
 List below your three most recent employers, beginning with the current or most recent one. If you were employed under a maiden or other name, please enter that name in the space below.

 Other/Previous/Maiden Name  
 May we contact your present employer?  
 
Job One: Name
 Address
Job Title
Name of Supervisor
 Phone
- -
Date Started
 Date Left
 Base Salary or Wage Start
 End
 Bonus
 Reason for Leaving
Job Two: Name
 Address
Job Title
Name of Supervisor
 Phone
- -
Date Started
 Date Left
 Base Salary or Wage Start
 End
 Bonus
 Reason for Leaving
Job Three: Name
 Address
Job Title
Name of Supervisor
 Phone
- -
Date Started
 Date Left
 Base Salary or Wage Start
 End
 Bonus
 Reason for Leaving
  U.S. Military
 Branch of Service  
 Date Entered 
 Date of Discharge 
 Highest Rank 
 Do you have service-related skills and experience applicable to civilian employment?
 If yes, describe:
 

 *During the past 5 years, have you ever been convicted of, pled guilty to or pled no contest to, a crime, excluding traffic  violations?*
(*A conviction will not necessarily bar you from employment)
If yes, describe in full: 
 

Are you or have you ever been a sex offender registered with any federal, state or local government agency, including any listing on a public web site?*
  OTHER
 Were you referred to Crescent City Foods Corp. by one of our crew members? If so, please provide us their name so we can thank them!

Name of crew member:

  PLEASE READ CAREFULLY THE SECTION BELOW BEFORE SIGNING.*
1. I certify that I have read this application and the information on it is complete and correct. I understand that any omissions or misrepresentation of information is grounds for dismissal.

2. I authorize the persons, employers, schools and organizations listed on this application to give you any information concerning my employment and other pertinent information they may have, personal and otherwise, and release all parties from all liability and damages that may result from furnishing this to you.

3. I acknowledge that Crescent City Foods Corp. reserves the right to amend or modify any of its handbooks or policies at any time and without prior notice. These policies do not create any promises or contractual rights between this employer and its employees. At this independently owned and operated Crescent City Foods Corp., employment is at will. This means an employee is free to terminate his/her employment at any time, without any reason, with or without cause, and the owner retains these same rights. The owner of this independently owned and operated Crescent City Foods Corp. is the only person who may make an exception to this, and any exception must be in writing, addressed to a particular individual, and signed by the owner.

4. Crescent City Foods Corp. is an Equal Opportunity Employer. Various federal, state, and local laws prohibit discrimination on account of race, color, religion, sex, age, national origin, disability or veterans status. It is Crescent City Foods Corp. policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law.

5. I understand that as a part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation, personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the name and address of the reporting agency that supplies the information.

6.  APPLICANTS MUST PASS A MANDATORY DRUG SCREEN PRIOR TO EMPLOYMENT
  *By choosing Yes, I agree that all of the above information is accurate.

  Today's Date*

  VOLUNTARY INFORMATION
The company is an equal opportunity employer committed to a diverse work force. In order to assist us in our efforts, we invite you to voluntarily provide responses to the following requests for information. Failure to respond will not subject you to adverse treatment. This information shall be kept confidential and separate from your application. Information provided will be used only in accordance with the law and for equal opportunity purposes.

Sex:
Race/Color/Origin: