Date* MM slash DD slash YYYY Position*Class A CDL DriverDollar Channel Service RepresentativeLoading SwingmanMaintenance Worker (Day Shift)Merchandiser (Full-Time)Merchandiser (Part-Time)Route HelperName* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Alternate Phone*Email Address*Expected pay range*When are you available to begin work?* MM slash DD slash YYYY How did you learn of our company or job opening?*Will you work overtime if asked?* Yes No Have you ever worked for us before?* Yes No Have you ever applied with us before?* Yes No Are you legally eligible to work in the U.S.?*Proof of your eligibility to work in the U.S. must be provided if selected for hire. Yes No Are you 18 years of age or older?* Yes No What languages do you speak and write fluently?*Check the days of the week you are available for work:*SundayMondayTuesdayWednesdayThursdayFridaySaturdayWhat hours of the day are you available for work?*Do you prefer* Daytime work Nightime work Criminal RecordHave you ever been convicted of a felony?* Yes No A conviction will not necessarily bar you from being considered for employment. Factors such as date of offense, nature of the crime and the position sought, and rehabilitation will be considered.If yes, what was the date of your felony conviction?*Offense:A conviction will not necessarily bar you from being considered for employment. Factors such as date of offense, nature of the crime and the position sought, and rehabilitation will be considered.RelativesDo you have friends/relatives working here?* No Yes Name:*Relationship:*Work HistoryProvide your work history for the previous 10 years. Start with present or most recent employer. Job 1Term of Employment* MM slash DD slash YYYY To* MM slash DD slash YYYY Employer*Address*PhoneSupervisor*Job Title and Description of Duties*Description*Pay Rate*Ending*Reason for Leaving*Do you have an additional work history to add?* No Yes Job 2Term of Employment* MM slash DD slash YYYY To* MM slash DD slash YYYY Employer*Address*Phone*Supervisor*Job Title and Description of Duties*Description*Pay Rate*Ending*Reason for Leaving*Do you have an additional work history to add?* No Yes Job 3Term of Employment* MM slash DD slash YYYY To* MM slash DD slash YYYY Employer*Address*Phone*Supervisor*Job Title and Description of Duties*Description*Pay Rate*Ending*Reason for Leaving*Do you have an additional work history to add?* No Yes Job 4Term of Employment* MM slash DD slash YYYY To* MM slash DD slash YYYY Employer*Address*Phone*Supervisor*Job Title and Description of Duties*Description*Pay Rate*Ending*Reason for Leaving*Do you have an additional work history to add?* No Yes Job 5Term of Employment MM slash DD slash YYYY To MM slash DD slash YYYY EmployerAddressPhoneSupervisorJob Title and Description of DutiesDescriptionPay RateEndingReason for LeavingUpload Resume (Optional)A resume is optional. Your resume must include your work history for the previous 10 years. Start with present or most recent employer, include the place of employment, the term of employment (ex. 4/2016 - 10/2020), job title, and description of duties.FileAccepted file types: pdf, Max. file size: 50 MB. Please explain the reason for any gaps in employment:*We may contact the employers listed above under your work history or on your resume. Please list any employer(s) you do not want us to contact and why:*Have you ever been discharged or asked to resign from a job?* No Yes Please explain why you were discharged or asked to resign from a job:Please explain why you would like to work for Acadiana Bottling Company:*Driving RecordMost positions in the company require driving a company vehicle. Not all positions require a CDL. Unless you are applying for a warehouse or clerical position you MUST complete this section.You must be at least 21 years old to drive a company vehicle.*Are you 21 years of age or older? Yes No Please list your address(es) for the last 3 years.Address 1 Street Address City State / Province / Region ZIP / Postal Code Address 2Address 2 Street Address City State / Province / Region ZIP / Postal Code Address 3Address 3 Street Address City State / Province / Region ZIP / Postal Code Driver's LicenseStateLicense NumberTypeExpiration DateDriving ExperienceClass of EquipmentNon-DOT RegulatedType of Equipment (Car, Van, Tank, Etc)Dates (From/To)Approximate # of milesStraight TruckType of Equipment (Car, Van, Tank, Etc)Dates (From/To)Approximate # of milesTractor and Semi-trailerType of Equipment (Car, Van, Tank, Etc)Dates (From/To)Approximate # of milesAccident Record for the last 3 years(Add rows by clicking the plus at the end of the row.)DateNature of Accident (head-on, rear-end, etc)Were you at fault? (Yes/No) Traffic convictions and forfeitures for the last 3 years(Add rows by clicking the plus at the end of the row.)DateLocationCharge Has any license, permit, or privilege ever been suspended or revoked? Yes No Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Yes No If your answer to either question is yes, please give details:Signature*The information provided in this application is correct and complete to the best of my knowledge. Misstatement or omission of information may result in refusal to hire or, if hired, dismissal from employment. I authorize Acadiana Bottling Co., Inc. (the “Company”), its representatives, and its agents to contact and obtain information from all references, employers, educational institutions, and any others to verify the accuracy of the information contained in this application. I release the Company, its representatives, and its agents from liability for seeking, gathering, and using such information and all other persons, corporations, or organizations for furnishing such information. If employed by the Company, I authorize any and all information concerning my employment with the Company to be furnished to any person/firm expressing what is deemed by the Company to be a valid interest in such information. I understand that as a condition of employment I may be required to take and pass medical tests as well as drug and alcohol screens. If employed, I will be subject to random, post-accident, and reasonable suspicion drug and alcohol screens. I understand the Company reserves the right to search anything brought onto company premises including (but not limited to) desks, lockers, briefcases, handbags, and automobiles. My actions on company time, whether or not on company property, may be under surveillance. I understand that as a condition of employment I will be required to comply with all Company rules and regulations. I understand that if employed, my employment will be at-will. The Company or I may terminate my employment at any time with or without cause or notice. My at-will status may be changed only by a written agreement signed by the President of the Company.
