Application for Employment

Position Applied For

Salary Desired

First Name

Last Name

Address

Phone

Business Phone

In case of emergency contact:

Emergency Contact Phone

What type of license do you have? OperatorCommercial Operator

Class

State Operator No.

Are you 18 years of age or above? YesNo

Are you legally eligible for employment in the United States?

Proof of citizenship or immigration status will be required upon employment.

YesNo

Will you authorize a motor vehicle license check? YesNo

Education

Education Level (Select all that apply) High SchoolCollegeBusiness or Trade SchoolProfessional School

High School

Number of Years Completed

Major & Degree

College

Number of Years Completed

Major & Degree

Business or Trade School

Number of Years Completed

Major & Degree

Professional School

Number of Years Completed

Major & Degree

Employment Experience

Give name and address of last three employers below.

1) Employer

Employer Address

Employer Phone

Name & Title of Supervisor

Employment Dates

Reason for Leaving

Work Performed

2) Employer

Employer Address

Employer Phone

Name & Title of Supervisor

Employment Dates

Reason for Leaving

Work Performed

3) Employer

Employer Address

Employer Phone

Name & Title of Supervisor

Employment Dates

Reason for Leaving

Work Performed

Personal References

1) Reference Name

Occupation

2) Reference Name

Occupation

3) Reference Name

Occupation

General Information

Have you ever been employed by our company? YesNo

Have you ever applied for employment with our company before? If so, when? YesNo

Will you abide by the safety rules of this company? YesNo

Preferred Office Location

Please select which of our office locations you would prefer to work from (check all that apply or none for no preference).

Baton RougeNew OrleansAustinDallasAtlanta

Upload your Resume

PLEASE READ THE FOLLOWING CAREFULLY AND SIGN BELOW

My signature on this application acknowledges that I have read the foregoing statement and agree to abide by it in full. My signature on this application also constitutes my consent to give a urine, blood and/or saliva sample to be used for drug and alcohol analysis. I also authorize the testing agency to provide the results of this test to MAPP. I authorize the company to contact any of my previous employers as well as any reference source in order to verify the facts and information I have furnished and regarding my qualifications and character. I hereby authorize any person(s) having knowledge thereof to provide such information to the company, and I hereby release from liability and agree to hold harmless any person that furnished such information in good faith. I agree that I will submit to a physical, urinalysis, saliva and/or blood or other examination requested by the company at any time prior to or subsequent to my employment. I further understand that my employment is for no fixed time and may be terminated at any time with or without cause or notice by myself or the company. I understand that no employee or officer or agent of the company may modify the employment at will relationship by oral or printed statements, including handbooks, benefit books, bulletins, or otherwise, contrary to the above. I have carefully read the information on this form. I warrant that all the information provided herein is true and correct. I acknowledge and understand that any inaccurate or false statement contained herein, as well as any omission, may result in rejection of my application or, in the event I have been hired, may result in termination of my employement.

Applicant's Signature

Date