Application For Employment
An Equal Opportunity Employer
 
ALL FIELDS ARE REQURED. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
 
Personal Information:
Full Name (First & Last):
Phone:
Email:
Social Security/Tax ID #:
Address:
City:
State:
Zip:
Are you 18 or order:
Date of Birth:
  
Do you have your own vehicle:
I understand that this is a smoke free work environment and will not smoke while at work
 
Desired Employment:
Position:
Date You Can Start:
  
Have you ever worked for Le Tache:
Are you currently employed:
If No, Why:
Do you have any friends/family that work for Le Tache:
If So, Who:
Are you a student:
Desired Salary (Hourly):
 
Availability:
I am currently looking for:
Locations Available (Check All That Apply):
Manassas - Breeden Ave Manassas - Nathan Ct Woodbridge
Dumfries Falls Church Springfield
Alexandria Chantilly Tyson's Corner
Alexandria (Old Towne) Leesburg Rockville, MD
Sterling   Manassas - Office/Warehouse/Driver
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Day Day Day Day Day Day Day
Night Night Night Night Night Night Night
I understand that I may work days and nights and every other Sunday
 
Employment History:
    Current or Previous Job (required):
Name Of Employer:
City:
State:
Zip:
Start Date:
  
End Date:
  
Position:
Starting Salary:
Ending Salary:
Supervisor:
Phone:
Description of work:
Reason for leaving:

    Previous Job (required):
Name Of Employer:
City:
State:
Zip:
Start Date:
  
End Date:
  
Position:
Starting Salary:
Ending Salary:
Supervisor:
Phone:
Description of work:
Reason for leaving:

    Previous Job 2 (required):
Name Of Employer:
City:
State:
Zip:
Start Date:
  
End Date:
  
Position:
Starting Salary:
Ending Salary:
Supervisor:
Phone:
Description of work:
Reason for leaving:
 
References (3 required):
Name:
Phone:
Relation:
Name:
Phone:
Relation:
Name:
Phone:
Relation:
 
Medical History:
Do you currently have any medical conditions that would prevent you from performing your duties with us, such as lifting objects weighing up to 70 lbs?
If yes, please explain:
Have you in the past had any medical conditions that would prevent you from performing your duties with us, such as lifting objects weighing up to 70 lbs?
If yes, please explain:
 
Time Off:
Do you have any planned time off in the next 6 months?
If so, please explain including dates:
 
Criminal History:
Have you been convicted of a felony within the last 5 years:
Are you currently on parole, probation or have any pending/current criminal trials?:
 
Photo (optional):
Attach a photo of yourself. Applications with photos generally get a faster response:
 
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statments on this application shall be grounds for immediate termination.
 
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. I also authorize the information provided on this application to be used for background and/or credit checks at the expense of the company.