Employment Application Form Employment application form Step 1 of 3 33% Your Personal InformationYour Name First Last Your Email Address Enter Email Confirm Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your PhoneBest Time To Call YouWhen is the best time for us to reach you via telephone?MorningsEarly AfternoonLate AfternoonEarly Evening Position You're Applying ForPosition You're Applying For(Required) Administrative Position Billing Position Lactation Consultant Are you currently an IBCLC?(Required) Yes No IBCLC Exam(Required) I am currently waiting for my IBCLC Exam Results I am planning to take the IBCLC exam in April I am planning to take the IBCLC exam in September I am not planning to sit for the IBCLC exam The IBCLC certification is requied to be hired as a Lactation Consultant with Bayou City Breastfeeding. You will need to submit an application for our internship program.IBCLC L Number (enter number only)(Required)Date of Original Certification(Required) Month Day Year Date of Expiration(Required) Month Day Year Hours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFriday Add RemovePrevious EmploymentYour Previous EmployersPlease list your previous employers, the dates you worked and the position you heldEmployerDatesPositionPhone Add Remove More About YouTell Us About YourselfUpload Your Resume and any all other supporting documents (certifications, etc.)Upload your resume and all other documents in .pdf, .doc or .docx format Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 25 MB. Terms and Conditions(Required)Consent and Terms & Conditions By submitting this employment application, I acknowledge and agree to the following: Accuracy of Information I certify that all the information provided in this application and any accompanying documentation is true, accurate, and complete to the best of my knowledge. I understand that any falsification, omission, or misrepresentation may result in the rejection of my application or, if employed, immediate termination of employment. Consent to Background Checks I authorize Bayou City Breastfeeding LLC to verify all information provided in this application, including but not limited to education, employment history, professional certifications, and references. I also consent to background checks, which may include criminal history, if required by the position for which I am applying. At-Will Employment I understand that completing this application does not guarantee an offer of employment. If hired, I understand that my employment will be at-will, meaning that either I or Bayou City Breastfeeding LLC may terminate the employment relationship at any time, with or without cause or notice, in accordance with applicable laws. Confidentiality of Information I acknowledge that any proprietary information provided by Bayou City Breastfeeding LLC during the application process is confidential and must not be shared or disclosed without explicit authorization. Use of Data I consent to the collection, processing, and storage of my personal information for the purposes of recruitment, employment decisions, and compliance with legal obligations. I understand that Bayou City Breastfeeding LLC will handle my personal data in accordance with applicable data protection laws and will not share my information without my consent, except as required by law. Acknowledgment of Policies If employed, I agree to abide by the company’s policies, procedures, and standards of conduct, including those outlined in the Employee Handbook and other official communications. Electronic Submission I understand that submitting this application electronically serves as my consent to the above terms and my electronic signature. By checking the box below and submitting this application, I acknowledge that I have read, understood, and agree to the above terms and conditions. I agree to the terms and conditions.
