Fillable Printable State of Louisiana Employment Application
Fillable Printable State of Louisiana Employment Application
![State of Louisiana Employment Application](/resources/formfile/images/10000/state-of-louisiana-employment-application-page1.png)
State of Louisiana Employment Application
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* Required field
Position applying for: (Please print and attach supplemental questions included in the posting for which you are applying)
*Job Title:___________________________________________________________Job#:______________________
*Agency: *Location:
NOTE: Any Supplemental Questions accompanying this job posting must be printed, answered, and submitted with this application or
your application will be considered incomplete
.
Contact Information
*Name
First Middle Initial Last
*Mailing Address
Street City State Zpi Code
*Email Address
*Home Phone Alternative Phone
*Social Security Number (Full # Required)
*By which method would you prefer to be notified about application status, testing dates and examination results?
(Note: if you select ‘E‐mail,’ you may still continue to receive paper notices from certain employers, depending on
their preference.)
Please check one of the following options: E‐mail
Other Personal Information
Mail
*Do you possess a valid Driver’s License? (Please check one)
Yes, I possess a valid Driver’s License. No, I do not possess a valid Driver’s License.
If Yes, Please provide the State and number
*Class: 1 2 3
4
A
A
CDL
B B CDL C C CDL CM D
E E (Learner) F M1 M2
Motorcycle R None
I consent to the release of information concerning my capacity and/or all aspects of prior job performance by employers, educational institutions, law
enforcement agencies, and other individuals and agencies to duly accredited investigators, human resources staff, and other authorized employees of the
state government for the purpose of determining my eligibility and suitability for employment.
I certify that all statements made on this application and any attached papers are true and complete to the best of my knowledge. I understand that the
information on this application may be subject to investigation and verification and that any misrepresentation or material omission may cause my
application to be rejected, my name to be removed from the eligible register and/or subject me to dismissal from state service.
I have read the statements above carefully before signing this application:
Signature of Applicant Date
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Additional Information
*Can you, after employment, submit proof of your legal right to work in the United States? (Please check one)
Yes No
*Please check the types of employment you will accept: Permanent Temporary
Certificates and Licenses
Type
License Number
Issued By
Date Issued
Date Expires
Additional Skills
*Are you currently at least 18 years old? Yes No
The State of Louisiana requests the information below so we may comply with federal Equal Employment
Opportunity law requirements. The information is strictly voluntary and in no way influences employment
prospects.
Gender: Male Female Decline to state
Ethnicity: Hispanic or Latino Non‐Hispanic or Non‐Latino Decline to state
Race: White/Caucasian Asian American Indian/Alaskan Native
Black or African American Native Hawaiian or other Pacific Islander
2 or more races Decline to state
Date of Birth (Month/Day/Year): / /
How did you find out about this job? Civil Service website Paper announcement at agency
Newspaper ad Flier Career Fair
Please select all that apply to you:
Word of mouth Other
I am a certified Vocational Rehabilitation Client. (Rule 22.8(a))
I have a 3.5 GPA or higher for my baccalaureate degree. (Rule 22.8(c))
I am an active duty member of the armed forces, or a veteran of the armed forces who has served at least
90 days of active service for purposes other than training and who has been honorably discharged from active
duty within the previous 12 months. (Rule 22.8(d))
I am eligible for Non‐competitive Re‐employment. (Rule 23.13)
I am a current permanent classified state employee in a job which requires the same Civil Service test as this
vacancy, and I have been in this job for at least the last six months.
None of the above.
*Are you an Army Pays participant? Yes No
To enable us to fully evaluate any military experience claimed, please list in the space provided below each rank and
grade you have held (e.g., include E, O or W grade) and the date that each was attained. If you do not have any military
experience, enter N/A.
* Are you claiming Veteran’s Preference points on this application? Yes No
If claiming Veteran’s Preference points, were you honorably discharged or discharged under honorable conditions
from the Armed Forces of the United States? Yes No Does not apply
Are you an honorably discharged veteran who served either in peace or in war and who has one or more disabilities
recognized as service‐connected by the Veteran’s Administration? Yes
No
* Required field
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* Required field
During which period did you serve? (check all that apply)
In the wartime period April 6, 1917 through November 11, 1918
In the wartime period September 16, 1940 through July 25, 1947
In the wartime period June 27, 1950 through January 31, 1955
In the wartime period July 1, 1958 through May 7, 1975
In a peacetime campaign or expedition for which campaign badges are authorized
Post 09/11/01 for 90 days or more and for purposes other than training
Does not apply/None of the above
Please select all that apply:
I am the spouse of a veteran whose physical condition precludes his or her appointment to a civil
service job in his or her usual line of work.
I am the unmarried widow of a deceased veteran who served in a war period as defined in the question
above, or in a peacetime campaign or expedition.
I am the un‐remarried widowed parent of any person who died in active wartime or peacetime service or
who suffered total and permanent disability in active wartime or peacetime service.
I am the divorced or separated parent of any person who died in wartime or peacetime service or who
became totally and permanently disabled in wartime or peacetime service.
None of the above
*Are you currently holding or running for an elective public office? Yes No
*Have you ever been on probation or sentenced to jail/prison as a result of a felony conviction or guilty plea to a
felony charge? Yes No
If “Yes”, please give the law enforcement authority (city, police, sheriff, FBI, etc.), the offense, place, and
disposition of case below.
*Have you ever been fired from a job or resigned to avoid dismissal? Yes No
If “Yes”, please explain below. A “Yes” answer will not necessarily bar you from state employment.
*If you are a male from the ages 18 through 25, please answer the following question “Yes” or “No”. If you are not
a male in this group, select “Does not apply”. Are you registered with the Selective Service System?
Yes No Does not apply
In which parishes are you available for employment? Acadia Allen Ascension
Assumption Avoyelles Beauregard Bienville Bossier Caddo
Calcasieu Caldwell Cameron Catahoula Claiborne Concordia
DeSoto E. Baton Rouge E. Carroll E. Feliciana Evangeline Franklin
Grant Iberia
Iberville
Jackson
Jefferson Jeff Davis
Lafayette Lafourche LaSalle Lincoln Livingston Madison
Morehouse Natchitoches Orleans Ouachita Plaquemines Pointe Coupee
Rapides Red River Richland Sabine St. Bernard St. Charles
St. Helena St. James St. John St. Landry St. Martin St. Mary
St. Tammany Tangipahoa Tensas Terrebonne Union Vermillion
Vernon Washington Webster W. Baton Rouge W. Carroll W. Feliciana
Winn
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* Required field
Education
*High School Name
Location
Have you received a high school diploma or equivalency certificate? Yes No
Give the name and address of the school, major course of study, and degree achieved:
Undergraduate University Graduate School
College Major Area of Study
Degree Attained Degree Attained
Year Year
Undergraduate Semester
Hours Completed
Undergraduate Quarter
Hours Completed
Graduate Semester Hours
Completed
Graduate Quarter Hours
Completed
Work History
Describe your work experience, beginning with your current or most recent job. Include military service,
volunteer work, self‐employment, and part‐time employment.
1. Name of Present or Last
Employer
Job Title _
Address
_ _
Phone Supervisor
From (Month/Year) / To / Hours Per Week
Salary Number of Employees Supervised
May we contact this employer? Yes No
Job Duties (give details)
Reason For Leaving
2. Your Next Most Recent
Employer
Job Title _
Address
Phone _ __ Supervisor
From (Month/Year) / To / Hours Per Week
Salary Number of Employees Supervised
May we contact this employer? Yes No
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* Required field
Job Duties (give details)
Reason For Leaving
3. Your Next Most Recent
Employer
Job Title _
Address
Phone _ __ Supervisor
From (Month/Year) / To / Hours Per Week
Salary Number of Employees Supervised
May we contact this employer? Yes No
Job Duties (give details)
Reason For Leaving
4. Your Next Most Recent
Employer
Job Title _
Address
Phone _ __ Supervisor
From (Month/Year) / To / Hours Per Week
Salary Number of Employees Supervised
May we contact this employer? Yes No
Job Duties (give details)
Reason For Leaving
5. Your Next Most Recent
Employer
Job Title _
Address
Phone _ __ Supervisor
From (Month/Year) / To / Hours Per Week
Salary Number of Employees Supervised
May we contact this employer? Yes No
Job Duties (give details)
Reason For Leaving