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Interested in learning more about what Buckhorn Services has to offer? Please contact us at 985-851-2330 or complete the form below to send us an email.

EMPLOYEE APPLICATION

General Info

Programs, services and employment are equally available to everyone. Please inform the Human Resources department if you require reasonable accommodation for the application or interview. Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical

Position Applied for:

How were you referred to us?

Name

Present Address

Phone

Email

Date Available to Start

Salary Requirment

If you are under 18 years of age, can you provide a work permit?

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*This Field is Required

Have you ever worked for this company?

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*This Field is Required

Are you legally allowed to work in the United States?

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*This Field is Required

Type of employment desired:

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*This Field is Required

Have you ever pleaded guilty, no contest or been convicted of a crime?

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*This Field is Required

Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Driver's license number (if applicable to position)

State

Education

Name & Location of High School

Name & location of College

Did you graduate?

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*This Field is Required

Trade, Business or Correspondence School

Did you graduate?

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*This Field is Required

Summarize Your Special Skills or Qualifications

Employment Desired

Dates of Employment

Address

Starting Salary and Title

Ending Salary and Title

Reason for Leaving

May we contact this employer for a reference?

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*This Field is Required

Add Employment

*Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical.

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability related or medial information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws." Job offers for employment will be contingent upon successful and satisfactory results of a drug screen and physical.

Signature of Applicant

Date

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