Form - La Palapa

EN
ES

LA PALAPA (SOUTHSIDE)

2000 W 34th St,
Chicago, IL 60608
Phone. 773-376-9620

LA PALAPA (NORTHSIDE)

3350 North Harlem Ave,
Chicago, IL 60634
Phone. 773-413-7177

Application for Employment

LA PALAPA is an Equal Opportunity Educational Institution and EEO/Affirmative Action Employer committed to excellence through
diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnicity, disability,
age, veteran status, or sexual orientation.

PLEASE TYPE OR PRINT. Complete the entire application. You may attach a resume, but you must still complete all questions; or your
application will be deemed incomplete and may not be considered.

Date

Position Applying For:

Name ( Last, First, Middle):

Other Names Under which you have been known:

Street Address:

City, State & Zip

Home Phone:

Work Phone:

Email:

Are you eligible to work in the United States?

Yes

No

Are you 18 years of age or older?

Yes

No

If NO, what is your current age?

Are you related to an employee at La Palapa?

Yes

No

Name & relationship to you?

Have you ever pleaded “guilty” or “no contest” to, or been convicted of a felony?

Dates Employed (most recent position)From:

Dates Employed (most recent position)To:

Title:

Organization Name and Address:

Supervisor’s Name, Title and Phone #:

Reason for Leaving:

Dates Employed (most recent position)From:

Dates Employed (most recent position)To:

Title:

Organization Name and Address:

Supervisor’s Name, Title and Phone #:

Reason for Leaving:

Dates Employed (most recent position)From:

Dates Employed (most recent position)To:

Title:

Organization Name and Address:

Supervisor’s Name, Title and Phone #:

Reason for Leaving:

SKILLS:

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.

I accept

Date

Submit

WORK EXPERIENCE-Please detail your entire work history. Begin with your current or most recent employer

PLEASE NOTE: LA PALAPA reserves the right to contact all current and former employers for reference information.

Dates Employed (most recent position)

I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize LA PALAPA to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of LA PALAPA serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the LA PALAPA Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal