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Baton Rouge

Lakeview Grocery

Application Form

Step 1 of 4

25%

Desired Work Location(Required)

Baton Rouge

Uptown

Metarie

Marigny

Lakefront

Personal Information

First Name(Required)

Last Name(Required)

Date(Required)

MM slash DD slash YYYY

Email(Required)

Phone Number(Required)

Address(Required)

Street Address(Required)

City(Required)

State(Required)

ZIP Code(Required)

Can you verify that you are at least 18 years of age?(Required)

Yes

No

If under 18, can you get a valid work permit?(Required)

Yes

No

Date Available to start work(Required)

Can you work over-time?(Required)

Yes

No

Total hours you are available to work per week?(Required)

Have you ever been employed with Robért Fresh Market or any of its partner companies before?(Required)

Yes

No

If yes when and why did you leave?(Required)

Do you have any relatives who work for Robért Fresh Market or any of its partner companies?(Required)

Yes

No

If yes, their names?(Required)

Location you are applying for?(Required)

Position you are applying for(Required)

Education

Type of School (High School, College, etc.)(Required)

School(Required)

Year in School(Required)

Graduated?(Required)

Legal

Are you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S.?(Required)

Yes

No

Have you ever been convicted of a crime other than a minor traffic violation?(Required)

Yes

No

If yes, please explain offense and final disposition(Required)

Employment History

Are you currently employed?(Required)

Yes

No

If so may we contact your current employer?(Required)

Yes

No

Please list your most recent Employment First

Employer #1

Employer

Position

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Salary

Final Salary

Final Salary

Street Address

Address Line 2

State

City

ZIP Code

Name of Supervisor

Phone

May We Contact?

Yes

No

If no, please explain

Reason for Leaving

Employer #2

Employer

Position

Date Started

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Untitled

Untitled

Employer Address

Street Address

Untitled

City

ZIP Code

Name of Supervisor

Telephone Number of Supervisor

May We Contact?

Yes

No

if no, please explain

Reason for Leaving

Employer #3

Employer

Position

Date

MM slash DD slash YYYY

Date Ended

MM slash DD slash YYYY

Starting Salary

Ending Salary

Employer Address

Street Address

Untitled

City

Untitled

ZIP Code

Untitled

Telephone Number of Supervisor

May We Contact?

Yes

No

If no, please explain

Reason for Leaving

Personal References

List

Name

Address

Phone

How did you hear about open positions to apply?(Required)

Indeed

Facebook

Family/Friend

In-Store Signage

Referred by Employee

Other

Please Read Carefully

IMPORTANT: READ CAREFULLY

I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for rejection or immediate dismissal. I understand that the use of this form does not indicate that there are positions open and does not in any way obligate the Company. If employed, I will comply with the Company’s rules and regulations. Further, I understand and agree that my employment is for no definite period of time and may, regardless of the date of payment of my wages and salary be terminated at any time, for any reason, without notice. No person other than the President of the Company may modify or amend the provisions stated herein. I hereby authorize release of any information regarding any criminal convictions that may exist against me and ask my former employer(s) and all other persons named herein who might have information concerning me to give any information regarding my former employment or any other information they may have regarding me whether or not the same is a matter of record and I hereby release them and each of them from any liability for any damage whatsoever which I could or might claim because of such disclosure.*

certify by checking this box that I have read and understood the above statement.(Required)

certify by checking this box that I have read and understood the above statement.

I certify by checking this box that all statements made by me on the application are true and complete.(Required)

I certify by checking this box that all statements made by me on the application are true and complete.

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Lakeview Grocery

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