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Employment

Employment Request


Today’s Date
Last Name* First Name*
Address* City*
State* Zip Code*
Phone No.* Cell No.
Email Address* Referred By
Position Desired Date You Can Start
Salary Desired ($ per hour)
Have you ever applied to PREJEAN’S before? If so, when?
Are you currently employed? May we inquire with your present employer?
Are you 18 years or older?
EDUCATION
High School Did you graduate?
City State

College Did you graduate?
City State
Course of Study Years Completed
Degree
Please list hours you are available to work
Monday AM Monday PM
Tuesday AM Tuesday PM
Wednesday AM Wednesday PM
Thursday AM Thursday PM
Friday AM Friday PM
Saturday AM Saturday PM
Sunday AM Sunday PM
We are an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, race, religion, or nation of origin.
Are there any physical conditions which may limit your ability to perform the job applied for?
If YES, please explain
IN CASE OF EMERGENCY
Name Relationship
Address City
State Zip Code
Phone No. Alternate No.
WORK HISTORY
Company Name Phone No.
Address City
State Zip Code
Salary Position
From To
Reason for leaving

Company Name Phone No.
Address City
State Zip Code
Salary Position
From To
Reason for leaving

Company Name Phone No.
Address City
State Zip Code
Salary Position
From To
Reason for leaving

Company Name Phone No.
Address City
State Zip Code
Salary Position
From To
Reason for leaving
REFERENCES
Please list below the names of three persons not related to you, whom you have known at least one year
Name Address
Business Years Acquainted

Name Address
Business Years Acquainted

Name Address
Business Years Acquainted
Have you ever been convicted of a felony? If so, please explain
I authorize investigation of all statements contained in this application. I understand that any misrepresentation or omission of facts is cause for dismissal. I understand and agree that my employment is for no definite period and may be terminated at any time without notice, regardless of the date of payment of my wages and salary.
* Indicates a required field.