Employment Application

Position for which you are applying? *
—Please choose an option—Housekeeping TechnicianQA InspectorQC Lab SupervisorQC Lab TechBreakdown PersonnelCapper Machine OperatorCatch Table PersonnelDump Table PersonnelFiller Machine OperatorFitment Machine OperatorLabel Machine OperatorStackerProduction Line SupervisorGeneral Maintenance PersonnelMachinistWelder/FabricatorForklift OperatorMixing SpecialistQC InspectorRoustaboutFacility Maintenance PersonnelElectricianOther

Check the following options you would consider:
Full TimePart TimeTemporary

If part time, specify hours or days:

Date available for work?

Do you have any commitments to another employer that might affect your employment with us?
—Please choose an option—YesNo

Is it OK for us to contact your current employer?
—Please choose an option—YesNo

Education and Training

GENERAL INFORMATION

Can you submit verification of your legal right to work in the US?
—Please choose an option—YesNo

List any relatives presently working for this organization

Have you ever been convicted of a crime, or pleaded no contest to a crime, resulting in imprisonment or a fine over $500 during the last ten years? (criminal convictions are not an automatic bar to employment, but will be considered in relation to specific job requirements.)
—Please choose an option—YesNo
If Yes, explain:

Employment History

List all work experience beginning with the present or most recent job

Character References (not employees or relatives) known to you for at least three years

Person to be notified in case of emergency:

Please include any other information which would be helpful to us in considering you for employment.

AGREEMENT (PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY) I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.
I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Peppers Unlimited of Louisiana, Inc., any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process. If employed by Peppers Unlimited of Louisiana, Inc., I agree to conform to the rules and regulations of Peppers Unlimited of Louisiana, Inc. I understand that this is not an employment contract. I know that my employment can be terminated at any time, for any reason, at my discretion or the discretion of Peppers Unlimited. I know that I also have the right to terminate employment at anytime, with or without notice, for any reason. I understand and agree I will be required to take a physical and drug and alcohol screening test. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also give my consent to the release of these test results to Peppers Unlimited of Louisiana, Inc. I understand any positive drug or alcohol result may preclude my employment and that I will be liable for the cost of the physical and drug screen. I also understand that the cost of my physical and drug screen will be deducted from my check if my employment with Peppers Unlimited of Louisiana, Inc. doesn't last more than three months.
Signature