FLEET CARDS CONTACT CONTACT US APPLY FOR CREDIT DEALER EQUIPMENT MAINTENANCE EMPLOYMENT CONTACT US Employment HOME ABOUT Application for Employment Federal Law prohibits discrimination on the basis of race, color, religion, disability, sex or national origin, as well as discrimination on the basis of age against persons between the age of 40 and 65 inclusive. Some state and city legislation prohibits discrimination because of age, marital status, sexual preference, race, color, religion, sex or national origin. Consult competent counsel for further interpretation. You may also download the employment application to be completed, printed and submitted in person. PERSONAL First Name Middle Name Last Name Street and number Social Security No. City and State Zip Phone Number How many addresses have you had in the last 5 years? How did you find out about this job? Newspaper Referral Other Driver's License # State Issued Expiration Date If hired, do you have a reliable means of transportation to get to work? Yes No Salary desired Least acceptable salary Are you a U.S. citizen? Yes No If no, do you have the legal right to work in the U.S. (i.e., green card)? Yes No Are you at least 16 years old? Yes No EMPLOYMENT DATA Are you seeking: Temporary Full time Part time What positions are you applying for? What hours and shift(s) would you prefer to work? Please indicate any shift(s) you would not be available to work Are you willing to work overtime? Yes No Weekends? Yes No Experience, Special Skills or Training Are you currently employed? Yes No When would you be able to start? Have you ever worked for this organization before? Yes No If yes, name used List any friends or relatives employed by this company Are you on layoff and subject to recall? Yes No Have you ever been discharged or asked to resign from any position? Yes No If yes, please describe How many days have you missed from school or work within the last 12 months? How many times have you been late to school or work in the last 12 months? How many days have you missed in the last 3 years for other than sickness? Please describe. EDUCATION Please choose the highest grade level of education attained. 1 2 3 4 5 6 7 8 9 10 11 12 G.E.D. Name and City If you attended college, how many years? 1 2 3 4 5 6 Name and City Degree and Major If currently in high schools, are you enrolled in a recognized co-op program (such as D.E., C.V.A., V.O.E.)? Yes No If yes, identify program and school MILITARY SERVICE Are you a veteran? Yes No If yes, give dates of service Special skills or training WORK HISTORY Please list your last 4 employers. Begin with the most recent employer. EMPLOYER #1 Company Name Employer Address Employer Phone Start Date End Date Job Title Give specific reason for leaving Supervisor's Name and Title Describe duties briefly Starting salary Ending salary EMPLOYER #2 Company Name Employer Address Employer Phone Start Date End Date Job Title Give specific reason for leaving Supervisor's Name and Title Describe duties briefly Starting salary Ending salary EMPLOYER #3 Company Name Employer Address Employer Phone Start Date End Date Job Title Give specific reason for leaving Supervisor's Name and Title Describe duties briefly Starting salary Ending salary EMPLOYER #4 Company Name Employer Address Employer Phone Start Date End Date Job Title Give specific reason for leaving Supervisor's Name and Title Describe duties briefly Starting salary Ending salary May we contact the employers listed above? Yes No If no, tell us which one(s) you do not wish us to contact and why. How many jobs have you had in the last 10 years that are not listed above? Why are you seeking a new position at this time? What is the job you have enjoyed most and why? List any outside interests including organizations you're active in that are business related: Bonding and money handling security policies require that we ask if you have ever been convicted of a felony? Yes No On parole? Yes No Awaiting Trial? Yes No If yes, state the nature of the offense and disposition of the case, include dates and places. NOTE: Felony convictions or the existence of a criminal record does not constitute an automatic bar to employment. I authorize this company to make an investigation of all information contained in this application for employment and I release from all liability all companies and corporations supplying such information. I understand that any false answers, statements or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle record and any other investigative report they deem necessary through various third party sources. Upon my formal written request, within a reasonable period of time, I will be notified as to the nature and scope of such investigation. I realize I hereby agree to submit to any drug test that may be required of me; whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a physical examination post-job offer and employment will be conditional upon passing such examination. During such employment, I understand and agree that in the event that I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company designated physician. I further understand that this is an application for employment and that no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and that the company may change wages, benefits and conditions at any time. My employment is at will. I have read and understand the above. Your Name Date Brands You Can Trust FRANKLIN, LA P.O. Box 265 2100 W. Main St. Franklin, LA 70538 (337) 828-1182 (800) 548-0146 (337) 828-1399 HOUMA, LA 1924 Coteaux Rd. Houma, LA 70364 (985) 872-5228 (985) 872-5653 OPELOUSAS, LA 605 N. Railroad Ave. Opelousas, LA 70570 (337) 942-2488 © 2021 All Rights Reserved | Dugas Oil Company Website by Wild Horse Creative