Employment Application General by zak16611


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									                           Original USA General Labor, LLC
                                          2910 Hwy. 1, P.O. Box 158
                                            Raceland, LA 70394
                                             Tel: (985) 446-1378
                                             Fax: (985) 448-0721

                                        Application for Employment

Date: _________________________                              Are you at least 18 years old: ___________

Name of Applicant: ______________________________ SS#: ___________________

Place of Birth: _________________________ Date of Birth: _____________________

Telephone#: _______________ US Visa Type/#: ____________ Exp. Date: ________

Present Address: _________________________________________________________

Permanent Address: ______________________________________________________

Person to contact in case of emergency: _______________________________________

Telephone Number of emergency contact: _____________________________________

Drivers License #: _______________ State issued: _________ Exp. Date: _________

Position Applied For: _______________________ Date you can begin: ____________

Certifications: ________________________ Other Skills: _______________________
Education: include trade schools and any special training.
Name of school                      Location                 Dates Attended
Previous Employment:
Name                         Address                From To         Position Held
1.   I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand
     that any false statements on this application shall be considered sufficient cause for termination of my contract.
     This company is hereby authorized to make any investigations to my prior educational and employment history.

2.   You will be working with and around machinery and equipment that can cause injury to yourself and others. In
     the interest of safety, you will be required to take and pass a urine test for drug and/or alcohol use. Your signature
     below signifies you consent to this test.

3.   I agree that if at any time my employment is terminated for any reason I will not seek employment with any
     customers of USA General Labor, Inc. for a period of ninety 90 days.

Signed: _____________________________________________________ Date: _________________

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