Application for Employment

Last Name

Position Desired

First Name

Middle

Job #

Laitram, L.L.C.
Human Resources Department
Post Office Box 50699
New Orleans, LA 70150

Dear Prospective Applicant:

Thank you for considering employment with Laitram and its subsidiary companies. Laitram includes six (6) whollyowned subsidiaries: Laitram Machinery, Inc.; Intralox, L.L.C.; Lapeyre Stair, Inc.; Laitram Machine Shop, L.L.C.;
Industrial Microwave Systems, L.L.C.; and Commercial Food Sanitation, L.L.C. These companies were founded on
innovative ideas and their successes are dependent upon talented employees with a commitment to excellence.
Nothing is more important to our success than the dedication of skilled, enthusiastic employees. To attract, retain and
motivate highly productive people, we provide fair compensation and benefit programs, and a safe and positive work
environment.
Laitram is an Equal Opportunity Employer. We do not unlawfully discriminate on the basis of race, color, religion,
gender/sex, national origin, age, marital or veteran status, disability or any other legally protected status. Please note
that all job offers are contingent upon completion of a satisfactory background investigation. Additionally, all job
offers are conditioned on the applicant's completing and passing a post-offer/pre-employment physical examination.
This examination includes a general physical, and a urinalysis (drug screen). A back exam/x-ray, nerve conduction
test, or fit for duty evaluation may be required for certain designated positions. If an applicant is unable to complete
and pass the post-offer/pre-employment physical examination, the job offer may be revoked. The entire cost of the
examination and drug screen are paid for by Laitram.
Please complete the Application for Employment in full even though you may be attaching a resume. Please note that
inactive applications will be discarded after a period of one (1) year.
Applicants requiring assistance to complete this application and/or in any subsequent interview process should notify
the Laitram Human Resources Department. Applicants can contact the Human Resources Department in writing
at the above address, or by calling (504) 733-6000 and asking for the Human Resources Department.
Thank you for taking the time to apply for a position with Laitram.

Sincerely,
Laitram, L.L.C.

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Instructions for Using Editable Applications

and Important Legal Stuff
1. Save the document to your local computer.
2. Complete the application by providing your responses in the areas provided; utilize the tab key to move
ahead to the next field.
3. If there is not enough space for any particular question, please include the full response in an additional
attachment to your application, as you would if you were completing a paper-based application.
4. When you have completed the application, please verify the application for accuracy and completeness
before signing and submitting the application.
5. If you choose to sign the application with a wet signature, please print the final application, sign the
application in ink and forward to Laitram at the address provided.
6. You hereby consent and agree that your use of a key pad, mouse or other device to apply your digital
signature constitutes your signature, acceptance and agreement as if actually signed by you in writing and
has the same force and effect as a signature affixed by hand. Further, you agree that the lack of a
certification authority or other third party verification will not in any way affect the validity or
enforceability of your signature. You can apply your signature electronically by clicking on the signature
field at the end of the applicaion.
7. If you experience technical difficulties utilizing the document, please contact Laitram at (504) 733-6000.

Next Page

If you wish to be considered for employment, you must read and sign the following Employee Dispute Resolution Agreement. You will not
be considered an applicant for employment until you have signed the Agreement. Included with this Application is a copy of The Laitram
Open Door Policy and Employee Dispute Resolution Program (EDRP). Please review this document carefully prior to signing the Agreement.
If the EDRP document is not included with this Application, it is your responsibility to request a copy from the Laitram Human Resources
Department prior to signing the Agreement. By signing this Agreement, you acknowledge that you have received the EDRP and that you
agree to its terms.

The Laitram Employee Dispute Resolution Agreement

I recognize that disputes may arise during the employment application process or my employment with Laitram, L.L.C. and/or its subsidiary
companies including, but not limited to, Intralox, L.L.C.; Laitram Machinery, Inc.; Lapeyre Stair, Inc.; Laitram Machine Shop, L.L.C.;
Industrial Microwave Systems, L.L.C.; and Commercial Food Sanitation, L.L.C. (hereinafter collectively Laitram). I further recognize that it is
in the best interest of both Laitram and me that these disputes be resolved in a manner that is fair, private, expeditious, economical, final and
less burdensome than court litigation. By applying for employment with Laitram, accepting an offer of employment with Laitram, and/or
continuing my employment with Laitram, I agree, as a condition of my employment or being considered for employment, to be bound by the
provisions of The Laitram Open Door Policy and Employee Dispute Resolution Program (EDRP).
Except for those disputes specifically excluded from the mediation and arbitration processes of the EDRP, both Laitram and I agree to use the
EDRP, including Non-Binding mediation and Final Binding Arbitration, as the sole means to resolve any and all previously unasserted disputes
arising out of or relating to my application or candidacy for employment, my employment and/or termination of my employment with Laitram.
I understand that if I file a lawsuit regarding a dispute arising out of or relating to my application or candidacy for employment, my employment
and/or termination of my employment, Laitram may use this Agreement in support of its request to the court to dismiss the lawsuit and
require me instead to use Non-Binding Mediation and/or Final Binding Arbitration to resolve the dispute as provided for in the EDRP.
I understand that I still may file administrative charges with the Equal Employment Opportunity Commission or other similar federal, state or
local agency, but that upon receipt of a right-to-sue letter or similar administrative determination, I shall mediate and/or arbitrate any covered
dispute that I may have against Laitram. Other than having an agreement between Laitram and myself to utilize and be bound by the EDRP, I
understand that neither this Agreement nor the EDRP form a contract of employment between Laitram and me. I further understand that my
signature to this Agreement in no way guarantees that Laitram will offer me employment. If Laitram offers me employment and I become
employed at Laitram, this Agreement in no way alters the at will status of my employment. I understand that my employment can be
terminated at any time, with or without cause, notice, or prior disciplinary action, at the option of either Laitram or myself.
This Agreement will be enforceable throughout the employment application process, my employment, and thereafter with respect to any disputes
arising from or relating to my application or candidacy for employment, my employment and/or termination of my employment with Laitram.
AGREED:

Check here to sign and acknowledge your acceptance of this agreement.

Printed Name

Date

Social Security Number

Laitram, L.L.C. and Subsidiary Companies by: James M. Lapeyre, Jr.

STOP!

If you have not signed the Agreement If you have decided not to sign the preceding Employee Dispute Resolution Agreement, then you
do not need to complete the balance of this application. Thank you for your interest in Laitram.
If you have signed the Agreement If you have signed and agreed to the terms of the preceding Employee Dispute Resolution
Program, then you will need to complete the balance of this application so we can continue with your application process.

SUBSIDIARIES:

LAITRAM MACHINERY, INC.

INTRALOX, L.L.C.

LAPEYRE STAIR, INC.

LAITRAM MACHINE SHOP, L.L.C.

INDUSTRIAL MICROWAVE SYSTEMS, L.L.C.

COMMERCIAL FOOD SANITATION, L.L.C.

Application For Employment

We consider applicants for all positions without regard to race, color, religion, gender/sex, national origin, age, marital or veteran status, disability or any
other legally protected status.

Name:

Last

Address:

First

Number & Street / P.O. Box

Middle

City

State

Zip Code

Telephone Numbers:
Home Phone

Business Phone

Email Address:

Mobile Phone

May We Contact You at Work?

Position Applying for:

Social Security Number

Yes

No

Date

Yes

No

Have you ever filed an application with us before? If yes, give date:

Yes

No

Have you ever been employed with us before? If yes, give date:

Yes

No

Yes

No

Are you currently employed?

Yes

No

May we contact your present employer?

Yes

No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

Yes

No

If you are under 18 years of age, can you provide required proof of your eligibility to work?
How did you learn of the job opening? (Check appropriate box)
Now Hiring Signs

Organization/School:

Laitram Website

Newspaper Advertisement:

NOLA.com

Friend:

Other:

Referred by (Current Laitram Employee Name):

Are you related to anyone currently working for our company?

If yes, give name & relationship:

Proof of citizenship or immigration will be required upon employment. Form I-9 must be submitted, verified and completed no later than 3 business
days after date of hire per the Immigration Reform and Control Act of 1986.

On what date would you be available to work?

Are you available to work: (Check all that apply)

Full Time

Part Time

Temporary

Shift Work

Night Shift

Are you willing to work overtime?

Yes

No

Are you currently on lay-off status and subject to recall?

Yes

No

Yes

No

Yes

No

Can you travel if a job requires it?

What percentage of a typical week are you available to travel?
Have you ever been convicted of a felony? If yes, please explain:

Conviction will not necessarily disqualify an applicant from employment.

Education
High School

Elementary School

School Name and Location

Undergraduate College/
University

Graduate/Professional

Years Completed
Diploma/Degree

Describe Course of Study

Describe any specialized training,

apprenticeships, skills, licenses,
certifications and extra-curricular
activities
Describe any honors you have
received
Provide any additional information
you feel may be helpful to us in
considering your application

Indicate any foreign languages you can speak, read and/or write
GOOD

FLUENT

FAIR

SPEAK
READ
WRITE

List professional trade, business or civic activities and offices held.

You may exclude memberships which would reveal gender/sex, race, religion, national origin, age, ancestry, disability or other legally protected status.

References
(List at least three business/work related references who are not relatives. Please include their names, their relationship to you, the company they work for,
and the telephone number at which they can be reached. Individuals with no prior work experience may use school or volunteer related references.)

Name

Relationship

Company

Telephone

Name

Relationship

Company

Telephone

Name

Relationship

Company

Telephone

Employment Experience
Start with your present or last job. Please complete fully even if you are attaching a resume. Please indicate if you were employed under a different
name. If you need additional space, please continue on a separate sheet of paper.

1. Employer:

Dates Employed
From

To

Work Performed

Address:
Telephone Number(s):

Hourly Rate/Salary
Starting

Job Title:

Final

Supervisor:

Reason for Leaving:

2. Employer:

Dates Employed
From

To

Work Performed

Address:
Telephone Number(s):

Hourly Rate/Salary
Starting

Job Title:

Final

Supervisor:

Reason for Leaving:

3. Employer:

Dates Employed
From

To

Work Performed

Address:
Telephone Number(s):

Hourly Rate/Salary
Starting

Job Title:

Final

Supervisor:

Reason for Leaving:

4. Employer:

Dates Employed
From

To

Work Performed

Address:
Telephone Number(s):

Hourly Rate/Salary
Starting

Job Title:

Final

Supervisor:

Reason for Leaving:

Are you subject to a personal restrictive covenant (e.g., non-compete and/or non-solicitation agreement)
with a current or former employer?
If yes, please explain:

Yes

No

Notice of Disclosure for Consumer Report,

Acknowledgment of Disclosure,
and Consent to Obtain Consumer Report
By this document, Laitram, L.L.C. and its subsidiary companies (Intralox, L.L.C.; Laitram Machine Shop, L.L.C.; Laitram
Machinery, Inc.; Lapeyre Stair, Inc.; Industrial Microwave Systems, L.L.C.; and Commercial Food Sanitation, L.L.C.)
disclose to you that a consumer report may be obtained for employment purposes as part of our pre-employment
background investigation and at any time during your employment. A consumer report may include information
concerning your character, employment history, general reputation, personal characteristics, criminal or police records,
motor vehicle records, mode of living, and/or credit history.
Before any adverse action is taken as a result of information contained in a consumer report, you will be provided with a
copy of the report and a summary of your rights under the Fair Credit Reporting Act. By signing below, you acknowledge
that Laitram has disclosed to you that Laitram may obtain a consumer report concerning you. You further acknowledge
receipt of this Notice of Disclosure and give consent to Laitram to obtain a consumer report from any source, including a
consumer reporting agency.
This form shall remain on file and serve as an ongoing authorization for Laitram to procure a consumer report as part of
Laitrams pre-employment background investigation and at any time during your employment with Laitram.

Check here to sign and acknowledge your acceptance of this agreement.

Print Name

Date

Authorization and Release Form for Background Information,

Consumer Reports, Application Verification and Related Information

Name:
Last

First

Middle

Address:
Number & Street / P.O. Box

City

State

Zip Code

Driver's License Number and State:

Social Security Number

I hereby authorize the investigation of all statements contained in my application for employment and I further authorize
Laitram, L.L.C. and its subsidiary companies to obtain the following information in connection with my application, regardless of
whether such information is written or oral: criminal and/or motor vehicle records, employment records, educational and

vocational records, consumer reports, including credit reports obtained through a consumer reporting agency. I
authorize my current and former employers, educational and vocational institutions, and any other individual or entity to
release the foregoing information.
I acknowledge and agree that Laitram may use this information in evaluating my application for employment and in its
decisions regarding hiring, compensation, promotion, reassignment, retention, and other terms and conditions of my
employment at Laitram.
I hereby release Laitram, and any individual or entity that provides information to Laitram, from any and all liability in
connection with the production, release and/or use of this information.
If an adverse employment decision is made based on a consumer report, I understand that I have the right to be informed
of the name and address of the consumer reporting agency providing such report.
I understand and agree that an offer of employment is contingent upon completion of a satisfactory background
investigation. If I am hired, I further authorize the investigation of any of the above information at any time during my
employment. If I have applied for or become employed in a position that requires me to operate a motor vehicle
(company owned or otherwise), I understand that an offer of employment may be revoked, or my employment
terminated, if my driving record is or becomes unsatisfactory.

Check here to sign and acknowledge your acceptance of this agreement.

Print Name

Date

Equal Employment Opportunity / Affirmative Action Data

Laitram, L.L.C. and its subsidiaries, Laitram Machinery, Inc.; Intralox, L.L.C.; Lapeyre Stair, Inc.; Laitram Machine Shop, L.L.
C.; Industrial Microwave Systems, L.L.C.; and Commercial Food Sanitation, L.L.C. (herein collectively Laitram), are Equal
Opportunity/Affirmative Action Employers, and as such, are required by federal law to maintain certain information
regarding applicants interested in employment.
You are invited to provide the following information VOLUNTARILY. This information will remain CONFIDENTIAL and
will be used only for purposes allowed by law. Refusal to provide such information will not subject you to any adverse
treatment nor will it become part of your personnel record should you become employed by Laitram.
Name:
Date
Address:
Number & Street / P.O. Box

City

State

Zip Code

Position Applying for:

Race / Ethnic Category

(Check appropriate box)

A.

Are you Hispanic or Latino?

B.

If you answer NO to question A, please mark one of the following:

Yes

No

White (not Hispanic or Latino)

Asian (not Hispanic or Latino)

Black or African American

(not Hispanic or Latino)

Hawaiian Native or Other Pacific Islander

(not Hispanic or Latino)

American Indian or Alaskan native

(not Hispanic or Latino)

Two or More Races (not Hispanic or Latino)

I decline to identify my race/ethnicity.

Gender
Male

Female

I decline to identify my gender.

If you wish, you can remove this form and return it to us at your convenience.

Certification and Acknowledgment

I certify that the information I have provided in this application (including all attachments) is true, correct and complete. I
understand that I will not be considered for employment if I have provided any false or misleading information, including the
omission of any facts, in this application or at any time during the employment application process. If I am hired and any
misrepresentation, falsification, or omission is discovered after I have begun employment, I understand that my employment is
subject to immediate termination.
I understand that this application for employment shall be considered active for a period of time not to exceed one (1) year. I
understand that I will be required to complete and pass a post offer/pre-employment physical, including a urinalysis (drug screen),
and that if employed, I may at any time be required to submit, if justified by business necessity, to a job related physical, urinalysis,
and/or other examination as a condition of my continued employment.
Because of the nature of Laitrams business, I understand that I am required to sign a confidentiality/patent agreement, which
prohibits the disclosing or using for personal gain any proprietary information (trade secrets). This agreement also requires the
assignment of certain intellectual property rights. I understand a copy of this agreement is available for my review at any time.
I understand and acknowledge that, unless otherwise defined by applicable law, my employment relationship with Laitram and/or
its subsidiary companies is of an at will nature, which means that I may resign at any time and I may be terminated at any time
with or without cause, notice or prior disciplinary action. Except for the provisions of The Laitram Open Door Policy and Employee
Dispute Resolution Program, which creates an agreement between Laitram and myself to utilize and be bound by the EDRP, I
further understand that no policies, procedures, correspondence or handbooks establish a contract or promise of any specific term
or condition of employment between myself, Laitram and/or its subsidiaries. It is further understood that this at will employment
relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing
by an authorized executive of Laitram and/or its subsidiary companies.
I understand that I am required to abide by all rules, regulations and procedures of Laitram and/or its subsidiary companies.

(In order to submit your virtual signature for all application pages,
you must check all signature boxes on the preceding pages.)

Date

Signature of Applicant

IMPORTANT:
Please be sure to read and sign
The Laitram Employee Dispute
Resolution Agreement.
2014 Laitram, L.L.C. 51382_English