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About Us Job Application

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Our Cooperative
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Job Application

Job Application

Step 1 of 4

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Position Applied For:(Required)

Name of person who referred you if applicable:

Applicant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Social Security Number(Required)

Cell Phone

Phone

If necessary, best time to call you at home is:

May we contact you at work?

Yes

No

Work Phone

Best time to call at work:

If you are under 18 and it is required, can you furnish a work permit?(Required)

Yes

No

Explain(Required)

Have you submitted an application here before?(Required)

Yes

No

Give dates:

Have you ever been employed here before?(Required)

Yes

No

Give dates:(Required)

Are you legally eligible for employment in this country?(Required)

Yes

No

Date available for work (mm/dd/yyyy)(Required)

Month

Day

Year

Type of employment(Required)

Full time

Part time

Temporary

Seasonal

Are you related to anyone here at JDEC?(Required)

Yes

No

How related?(Required)

Are you able to meet the attendance requirements of the position?(Required)

Yes

No

Will you work overtime if required?(Required)

Yes

No

Please explain(Required)

Have you ever been bonded?(Required)

Yes

No

Have you ever been convicted of a crime in the last 7 years?(Required)

Conviction will not necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying.

Yes

No

Please explain(Required)

Employment History

Provide the following information for your past and current employers, assignments, or volunteer activities, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in comments section below.

Employer(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Job Title(Required)

Supervisor(Required)

Dates Employed(Required)

Start Rate of Pay

End Rate of Pay

Reason for Leaving(Required)

May We Contact for Reference?(Required)

Yes

No

Additional Employment?(Required)

Yes

No

Employer(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Job Title(Required)

Supervisor(Required)

Dates Employed(Required)

Start Rate of Pay

End Rate of Pay

Reason for Leaving(Required)

May We Contact for Reference?(Required)

Yes

No

Additional Employment?(Required)

Yes

No

Employer(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Job Title(Required)

Supervisor(Required)

Dates Employed(Required)

Start Rate of Pay

End Rate of Pay

Reason for Leaving(Required)

May We Contact for Reference?(Required)

Yes

No

Attach Additional Sheet if Necessary

Drop files here or

Max. file size: 100 MB.

Educational Background

List the last 3 schools attended, starting with the most recent, list number of years completed, indicate degree or diploma earned, if any, and field of study.

Education(Required)

(Click the + button to add a new row)

School

Years Completed

Degree

Field of Study

References

List name and telephone number of 3 business/work references who are not related to you and are not previous supervisors. If not applicable, list three schools or personal references who are not related to you.

References(Required)

(Click the + button to add a new row)

Name

Phone Number

Years Known

Additional Information

list professional, trade, business or civic associations and any offices held. Exclude memberships which would reveal sex, race, religion, national origin, age, disability or any other similarly protected status.

Additional

(Click the + button to add a new row)

Organization

Offices Held

List special accomplishments, publications, awards, etc. Exclude memberships which would reveal sex, race, religion, national origin, age, disability or any other similarly protected status.

Signature & Consent

Applicant Consent(Required)

I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

RE: Drivers Privacy Protection Act (18 U.S.C. #2721 et seq.)

I am aware of the Driver's Protection Act, effective September 13, 1997, which prohibits a state department of motor vehicles from disclosing, or otherwise making available to any person, information about my personal motor vehicle record without my written consent.

I here by give my consent to request and review my State Department of Motor Vehicle Records (MVR). This is done as a condition of employment, and to obtain these records periodically during the term of my employment in order to comply with the company's loss control program.

Driver's License Number(Required)

Date of Birth (mm/dd/yyyy)(Required)

Month

Day

Year

Applicant Electronic Signature (Full Name)(Required)

Stay in Touch

Main Office

906 North Lake Arthur Avenue
Jennings, LA 70546

Directions to Main Office

Mailing Address

PO Drawer 1229
Jennings, LA 70546

Charles S. Hackett Office

815 Highway 27
Sweet Lake, LA 70630

Directions to Branch Office

Social Media

Office Hours

Monday through Thursday
7 a.m. to 4:30 p.m.

Friday
7 a.m. to 3:30 pm.

Phone Numbers

Jennings Office Phone: (337) 824-4330

Branch Office Phone: (337) 598-5700

Jennings Office Fax: (337) 824-8936

Branch Office Fax: (337) 598-5708

After Hours Outages: (800) 256-5332

Automated Phone System:
(337) 221-8928

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