Flora-Bama Pre-Application for Employment

PRE-APPLICATION FOR EMPLOYMENT
Flora-Bama®
17401 Perdido Key Drive
Pensacola, FL 32507

Flora-Bama® is a leased work force by OASIS Outsourcing, which is a drug-free work place.

We are an Equal Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status or the presence of a medical condition or handicap. We are, however, greatly influence by enthusiasm, energy, willingness to learn and hard work.

PERSONAL INFORMATION (Please Type Information Then Print, Sign, Date and Drop Off or Mail to Address Above)

Date:

- - (MM/DD/YY)

Social Security Number:


Name:
	Last	First	Middle

Address:
	Street Address	City	State	Zip

Other Names You Are Known By:

Home Phone:

() -

Date available for work:

- - (MM/DD/YY)

Range of pay desired:

Referred by:

Position Desired:

Are you at least 18 years of age?

Yes

If NO please state your age:

In the state of Florida you must be 18 years of age or older to serve alcohol.


Are you currently employed?	Yes	No	May we inquire of your present employer?	Yes	No

Specify hours you are available for work each day:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Hours	Hours	Hours	Hours	Hours	Hours	Hours

Have you ever been convicted, plead guilty, pled no contest (or nolo contendre), or had a court withhold
adjudication for any crime, felony or misdemeanor (other than a minor traffic offense)? Yes No
A conviction will not necessarily disqualify you from employment.

If YES, state the nature of the offense and the date the offense took place:

EDUCATION

	High School	College/ University	Graduate/ Professional
School Name
School Location
Years Completed
Diploma/ Degree	Yes No	Yes No	Yes No
Course of Study

EMPLOYMENT RECORD

List in order starting with present or last employer. Please explain any gaps in employment.

Dates Employed

From:

-- (MM/DD/YY)

To:

-- (MM/DD/YY)

Company:

Address:

Phone:

() -

Starting Salary:

Ending Salary:

Principal Duties:
Reason for Leaving:

Dates Employed

From:

-- (MM/DD/YY)

To:

-- (MM/DD/YY)

Company:

Address:

Phone:

() -

Starting Salary:

Ending Salary:

Principal Duties:
Reason for Leaving:

Dates Employed

From:

-- (MM/DD/YY)

To:

-- (MM/DD/YY)

Company:

Address:

Phone:

() -

Starting Salary:

Ending Salary:

Principal Duties:
Reason for Leaving:

SPECIAL INTERESTS: Summarize special skills and qualifications acquired from employment or other experience. List professional, trade, business or civic activities and offices held (which may be useful to this company). Exclude groups which indicate race, color, religion, sex or national origin.

I certify that the information contained in this application for employment is true and correct, without any omissions or misleading statements. I authorize Flora-Bama® Lounge & Package and/ or OASIS Outsourcing (“OASIS”) to investigate and verify all information contained in this application, unless herein specifically stated otherwise. I authorize former employers, references, schools, doctors, and law enforcement agencies to release information related to my background, prior performance, and verification of information stated in this application. I understand and agree that Flora-Bama® Lounge & Package/ OASIS may reject my application for false statements, misleading statements, or omissions made in connection with my application. I agree, that if I am employed, false statements, misleading statements, or omissions shall be considered cause for dismissal and that Flora-Bama® Lounge & Package/ OASIS shall not be held liable for terminating my employment.

EMPLOYEE NOTICE: I, the undersigned employee, acknowledge by my signature that I have been informed that I may be a leased employee of OASIS leased to Flora-Bama®. I further understand that either OASIS or I can terminate our employment relations at any time, as I am an At-Will employee. I also acknowledge that while I am a leased employee of OASIS, if OASIS does not receive payment from the client for services which I perform as a leased employee, OASIS will pay me the applicable minimum wage (or the legally required overtime pay in a work week in which I worked overtime) for any such pay period and I agree to this method of compensation. I understand and agree that no representative of Flora-Bama® has any authority to any agreement for my employment, or for any specified period of time, unless it is in writing and signed by an Officer of the Flora-Bama. In all instances, I understand and agree that as a leased employee of OASIS, I will be employed as an At-Will employee despite any other relationship with Flora-Bama®.

EQUAL OPPORTUNITY AND HARASSMENT: I ALSO AGREE THAT IF AT ANY TIME DURING MY EMPLOYMENT I AM SUBJECTED TO ANY TYPE OF DISCRIMINATION, INCLUDING DISCRIMINATION BECAUSE OF RACE, SEX, AGE, RELIGION, COLOR, VETERAN STATUS, RETALIATION, NATIONAL ORIGIN, HANDICAP, DISABILITY OR MARITAL STATUS, OR IF I AM SUBJECTED TO ANY TYPE OF HARASSMENT, I WILL IMMEDIATELY CONTACT OASIS OUTSOURCING’S HUMAN RESOURCE DEPARTMENT AT 1-800-881-4488 IN ORDER TO OBTAIN ASSISTANCE IN THE RESOLUTION OF SUCH MATTERS.

Signature:

_____________________________________________

Date:

________________________