interested in working at our Jefferson: Jefferson Highway location?Fill out the employment application below. Which Pelican Pointe Location are you interested in applying for? * CHOOSE the location from the dropdown box below. David Drive- Metairie West Esplanade-Metairie Airline Drive- Metairie South Claiborne- New Orleans Jefferson Highway- Jefferson Florida Street- Mandeville Highway 25- Covington Highway 21- Covington West Airline Highway-Laplace Behrman Hwy-Terrytown West Judge Perez-Chalmette Name First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * Phone * (###) ### #### Email * Date Available to Work: * Today's Date * Desired Salary * Position Applied For * Are you a citizen of the United States? * Yes No If the above answer is NO, are you authorized to work in the U.S.? Yes No Have you ever worked for this company? * Yes No If above answer is YES, when did you work for this company? Have you ever been convicted of a felony? * Yes No EDUCATION: HIGH SCHOOL High School Name: Address of High School: Years Attended: Did you graduate? If so, what degree did you receive? EDUCATION: College College Name: Address of College: Years Attended: Did you graduate? If so, what degree did you receive? EDUCATION: Other Schooling Name of Other School: Address of Other School: Years Attended: Did you graduate? If so, what degree/certification did you receive? REFERENCES: Please list THREE professional references. * REFERENCE 1: FULL NAME, RELATIONSHIP, COMPANY, and PHONE NUMBER * REFERENCE 2: FULL NAME, RELATIONSHIP, COMPANY, and PHONE NUMBER * REFERENCE 3: FULL NAME, RELATIONSHIP, COMPANY, and PHONE NUMBER PREVIOUS EMPLOYMENT: Start with most recent/current employer. EMPLOYER # 1: Company: Company Phone Number Company Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities Years Worked at This Company: (example: May 1997- February 2002) Reason for Leaving May we contact your previous supervisor for a reference? EMPLOYER # 2: Company Company Phone Number Company Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities Years Worked at this Company: (example: May 1997- February 2002) Reason For Leaving May we contact your previous supervisor for a reference? EMPLOYER # 3: Company Company Phone Number Company Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities Years Worked at this Company: (example: May 1997- February 2002) Reason for Leaving May we contact your previous supervisor for a reference? MILITARY SERVICE: Please complete if applicable. Branch: Years Served: Rank at Discharge: Type of Discharge: If other than honorable, explain. DISCLAIMER AND ELECTRONIC SIGNATURE * I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By typing my name in this Electronic Signature Acknowledgment Form, I agree that my electronic typed signature is the legally binding equivalent to my handwritten signature. I acknowledge Pelican Pointe Carwash will use my electronic signature to act on my behalf. Type Full Name Below: * Today's Date: Thank you!