Application for Employment

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Date

Name (AS SHOWN ON SOCIAL SECURITY CARD):

Last

First

Middle

Address

Street

Apt

City

State

Zip

Other personal details:

Phone Number

Social Security Number

Other phone number(s) where you can be reached

List other names you have used, including nicknames and aliases:

Referral:

Were you referred by a SF&NS employee?

Name:

Emergency Contact Number:

Name

Telephone Number

Additional information:

Have you ever filed an application with this office before?

If yes, give approximate date:

Month

Enter month in number format, e.g. 3 for March.

Year

Only enter the last two numbers of the year, such as 13 for 2013.

Name on application

Have you ever been employed by this department?

If yes, give dates:

Month previous employment here began:

Enter month in number format, e.g. 3 for March.

Year previous employment here began:

Month previous employment here ended:

Enter month in number format, e.g. 3 for March.

Year previous employment here ended:

Do any of your relatives work here?

If yes, state name, relationship and location

Are you presently employed?

Yes or No

If so, why do you wish to change jobs?

May we contact your present employer?

If not employed, state reason for leaving last position

If regular work is not available, would you be interested in substitute work OR part time work?

Substitute work
Part time work

List area(s) where you are interested in working

List school(s) where you are interested in working

The job requires that you be in attendance and on time every morning possibly as early as 6:30 A.M. or 7:00 A.M. Would this present any problems for you?

Have you ever been convicted of a misdemeanor or felony? (Such a conviction may be relevant if job related, but may not bar you from employment.)

Do you have a vehicle at your disposal throughout the work day?

EDUCATION:

EMPLOYMENT:

List your complete work history, starting with your most recent job and going back to your first employment. Include periods of unemployment.

List your complete work history, starting with your most recent job and going back to your first employment. Include periods of unemployment.

1st employer (or period of unemployment): month started

Enter month in number format, e.g. 3 for March.

1st employer (or period of unemployment): year started

1st employer (or period of unemployment): month ended

Enter month in number format, e.g. 3 for March.

1st employer (or period of unemployment): year ended

1st employer: company name

1st employer: address

1st employer: city and state

1st employer: position

1st employer: reason for leaving

1st employer: supervisor's name

1st employer: phone number

2nd employer (or period of unemployment): month started

Enter month in number format, e.g. 3 for March.

2nd employer (or period of unemployment): year started

2nd employer (or period of unemployment): month ended

Enter month in number format, e.g. 3 for March.

2nd employer (or period of unemployment): year ended

2nd employer: company name

2nd employer: address

2nd employer: city and state

2nd employer: position

2nd employer: reason for leaving

2nd employer: supervisor's name

2nd employer: phone number

3rd employer (or period of unemployment): month started

Enter month in number format, e.g. 3 for March.

3rd employer (or period of unemployment): year started

3rd employer (or period of unemployment): month ended

Enter month in number format, e.g. 3 for March.

3rd employer (or period of unemployment): year ended

3rd employer: company name

3rd employer: address

3rd employer: city and state

3rd employer: position

3rd employer: reason for leaving

3rd employer: supervisor's name

3rd employer: phone number

REFERENCES: (Do not include relatives)

1st reference: name

1st reference: occupation

1st reference: phone number

2nd reference: name

2nd reference: occupation

2nd reference: phone number

3rd reference: name

3rd reference: occupation

3rd reference: phone number

This application is made with the understanding that I must furnish my Social Security Card or Birth Certificate and Driver’s License or State ID when hired. I recognize that any false information given on this application is grounds for rejection and/or dismissal should School Food & Nutrition Services of New Orleans, Inc. employ me. I also authorize School Food & Nutrition Services of New Orleans, Inc. or its representative, to contact all persons or organizations listed above as references and/or previous employer(s) for information pertinent to this application for employment.

By my signature below, I hereby authorize any prior and/or present employers to release information requested by School Food & Nutrition Services of New Orleans, Inc., that verifies the fact of and/or years of employment. I further agree to release, hold harmless and indemnify School Food & Nutrition Services of New Orleans, Inc., its directors, officers, and employees as well as any prior or present employers from any and all claims that may arise from such verification.

Applicant’s Signature

Date

THIS APPLICATION IS NOT VALID UNLESS SIGNED AND DATED

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

This application will remain on file for the current or upcoming school year. If you are not called for an interview appointment within that period, it will be necessary to re-apply.

PLEASE READ CAREFULLY BEFORE SIGNING

I understand and agree that:

Any false or misleading statement in this application for employment or in any statements made to representatives of School Food and Nutrition Services or in any additional forms completed by me in connection with my employment shall also be sufficient cause for refusal of or separation from employment.
It is my understanding that School Food and Nutrition Services (hereafter referred to as “the company”) will, at its sole option, make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the company and I release from liability any person(s) giving or receiving such information. I understand that falsification of information so given or other derogatory information discovered as a result of this investigation may prevent my being hired, or, if hired, may subject me to immediate dismissal.
I further understand that, as a condition of my employment I will be fingerprinted for an investigation to determine all criminal record information that may be deemed relevant to my employment and that a urine specimen will be collected for analysis for substances of abuse only.
I agree that the company, at any time may terminate my employment without liability for wages or salary except such as may have been earned as of the date of such termination. I authorize any physician or health care entity to release any information which may be necessary to determine my ability to perform the duties of the job I am being considered for prior to employment or in the future during my employment with the company. I consent to take a medical examination by a qualified health care provider at the discretion of my employer. I have no knowledge of any physical or mental disability that would prevent me from performing the work required, with or without accommodation. Failure to answer truthfully may result in the forfeiture of Workers’ Compensation benefits.
The following conditions are mandatory: working hours will not exceed seven (7) per day for full time employees. However, these hours may be reduced to accomplish the meals-per-man-hour ratio as determined by the company. Part time employees are those employees working four (4) hours or less per day.
I understand that this is an application for employment and that no employment contract is being offered.
I understand that if I am employed, my employment is terminable at will at any time by my employer and that my employer can change wages, benefits and/or conditions of employment at any time.
I understand that I am employed as a substitute and my starting salary will remain at a fixed standard hourly rate until I successfully complete all entry level requirements and obtain regular status with the company.
I understand and accept these conditions of employment.

Signature

Date

Employee Notification and Authorization

This is used to inform you that a background report is being obtained from a consumer reporting agency for the purpose of evaluating you for employment, volunteer service or a contracted position, including retention as an employee, volunteer or independent contractor.

This report may contain information bearing on your character, general reputation, and personal characteristics from public or private record sources.

To whom it may concern:

I understand that a background report as described above may be obtained. All law enforcement agencies, State Police and courts are authorized to release all written information about me. I give permission for a criminal background check to be conducted on me and hereby release all individuals, companies, corporations and agencies, public or private, connected therewith from any and all liability associated with the dissemination of such information.

Candidate Information

Please Print

First Name:

Middle Name:

Last Name:

Month of birth:

Day of birth:

Year of birth:

Social Security Number:

Street:

City:

State:

Zip:

Gender

Male
Female

Signature:

Date:

Email address: