Personal
E-mail:
Telephone Number:
/hour.
 Position Applied For:
Salary Expected:
Name (First, Middle, & Last):
Home Address:
When would you be available to begin work?
Have you ever worked under another name?
Yes
 No
If yes, give name(s):
Have you ever worked for this company?
Yes
 No
If yes, specify:
Have you ever applied for employment with us?
Yes
 No
If yes, month and year:
Are you legally eligible for employment in the U.S.?
Yes
 No
If no, what is your immigration status?
Can you work overtime?
Yes
 No
Can you work shifts?
Yes
 No
What type of work are you seeking?
Full-time
 Temporary
Part-time
Hours Available to Work:
Are you 18 years of age or older?
Yes
 No
Have you ever been convicted of a felony or misdemeanor crime within the
last 10 years?
No
Yes
If yes, explain (conviction will not necessarily disqualify you from employment)
Education
School
Name and Location of School
Course
Of Study
# of Years
Completed
Did You
Graduate?
Degree of
Diploma
College
Yes
No
High School
Yes
No
Elementary
Yes
No
Other
Yes
No
Are you a Student?
 Yes
 No
 Full-Time
Part-Time
Are you planning to pursue further studies?
Yes
 No
 Full-Time
Part-Time
If yes, when and where, and what courses of study?
Employment History
Please give accurate, complete full-time and part-time employment record.  Start with present or
most recent employer.
1
Company Name / Type of Business:
Address:
Name of Supervisor:
State Job Title and Describe Your Work
Full-Time
 Part-Time
May We Contact for Reference?
 Yes
No
If No, Reason:
Telephone Number:
Employed (Month / Year)
From
 To
Salary / Hourly Rate
Start
 Last
Reason For Leaving:
2
Company Name / Type of Business:
Address:
Name of Supervisor:
State Job Title and Describe Your Work
Full-Time
 Part-Time
May We Contact for Reference?
 Yes
No
If No, Reason:
Telephone Number:
Employed (Month / Year)
From
 To
Salary / Hourly Rate
Start
 Last
Reason For Leaving:
3
Company Name / Type of Business:
Address:
Name of Supervisor:
State Job Title and Describe Your Work
Full-Time
 Part-Time
May We Contact for Reference?
 Yes
No
If No, Reason:
Telephone Number:
Employed (Month / Year)
From
 To
Salary / Hourly Rate
Start
 Last
Reason For Leaving:
4
Company Name / Type of Business:
Address:
Name of Supervisor:
State Job Title and Describe Your Work
Full-Time
 Part-Time
May We Contact for Reference?
 Yes
No
If No, Reason:
Telephone Number:
Employed (Month / Year)
From
 To
Salary / Hourly Rate
Start
 Last
Reason For Leaving:
5
Company Name / Type of Business:
Address:
Name of Supervisor:
State Job Title and Describe Your Work
Full-Time
 Part-Time
May We Contact for Reference?
 Yes
No
If No, Reason:
Telephone Number:
Employed (Month / Year)
From
 To
Salary / Hourly Rate
Start
 Last
Reason For Leaving:
Military History
Complete this section if you have served in the U.S. Armed Forces.
Branch of Service:
Period of Active Duty (Month & Year)
 To
Rank At Discharge:
Date of Final Discharge:
Describe Your Duties and Any Special Training:
Personal References
List name and phone number of 3 business / work references who are not related to you and are
not previous supervisors.
Name, Job Title, Company
Phone Number
Years Known
Organizations
List professional, trade, business, or civic associations and offices held, special
accomplishments, and awards (exclude information which may reveal sex, race, religion,
national origin, age, ancestry, handicap, or other protected status.
Special Skills
Summarize special skills and qualifications acquired from employment and other experiences.
Click Here To Read Application Agreement
By pressing Submit, you agree to the terms of the agreement of this application.  If you do not agree to
the terms of this application please press clear and/or close your browser.  Any questions about this
application may be received at (985) 526-4512 or brandon@robertsfoodstore.com.
The following information is requested in order to help us evaluate and analyze your skills and
ultimately to make the best possible placement within the company.  All portions of this application
pertaining to you must be completed.  The company, in accordance with state and federal laws,
does not discriminate on the basis of age, race, religion, color, sex, national origin, or physical or
mental handicap.