Join Our Team - Pops and Rockets

Contact Information

Name*

First Last

Drivers License Number*

Drivers License State*

Address*

Street Address City State ZIP Code

Cell Phone*

Email*

Date of Birth*

Do you have the legal right to live and work in the U.S.?*

Yes
No

Names of friends or relatives employed in this organization

Have you ever applied to Pops and Rockets before?*

Yes
No

Have you been employed by Pops and Rockets before?*

Yes
No

Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities?*

Yes
No

Do you have any physical or mental condition or handicap which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

Will you comply with the safety work and attendance policies of our organization?*

Yes
No

Position, Schedule and Availability

Position(s) Desired or Area of Interest:*

Retail position in shop.
Making Pops and Ice Cream
Working Events
Making Deliveries

Desired hours.*

Part-time
Full-Time
Second Job (if you are already working)
Temporary

Shifts you can work:*

Please check all the times that you are available to work.

How will you get to work?*

How were you referred to Pops and Rockets?*

Social Media
Friend or Family Member
Employee
Other Company
Self

Eduction / US Military

Education*

I am currently attending high school.
I am a high school graduate/have my GED.
I am attending college (in Lake Charles).
I am attending college (outside of Lake Charles).
I am a college graduate.
I am not in school.

Check all that apply.

Have you ever served in the U.S. Armed Services?*

Yes
No

Prior Work Experience

Please list most recent position first with Employer name, Position held, start date, time at employer, reason for leaving, and supervisor name and phone number.

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Start Date

Years in Position

Supervisor Name

Description of Duties

Reason for leaving.

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Employer Name

Address

Street Address City State ZIP Code

Phone

Position Held

Start Date

Years in Position

Supervisor Name

Description of Duties

Reason for leaving.

May we contact this employer?

Yes
No

Would you like to list a 3rd employer?

Yes
No

Employer Name

Address

Street Address City State ZIP Code

Phone

Position Held

Start Date

Years in Position

Supervisor Name

Description of Duties

Reason for leaving.

May we contact this employer?

Yes
No
Third Choice

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name	Phone	Email	Occupation	Years Known

Acknowledgement

Digital Signature

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

Resume Upload (Optional)

If you have a resume you'd like to attach, please do so here. This is not required.

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.