EMPLOYMENT APPLICATION

Which restaurant(s) are you applying to work at with this application? *
Position(s) applied for:
How did you hear about this job? *
Why are you seeking a new job at this time?

Applicant Information

Name
Address
City
State
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   * Zip
If hired, do you have a reliable means of transportation to get to work?
 Yes  No * Describe:
Are you at least 18 years old?
 Yes  No * If you are under 18 years of age, can you furnish a work permit?
 Yes  No If the job you are applying for requires driving:
License No:
State:
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   Expiration Date:
Are you legally eligible for employment in the U.S.?
(Proof of U.S.Citizenship or immigration status is required if hired)
 Yes  No Have you been convicted of a crime? (Massachusetts applicants should not include misdemeanor convictions; California applicants should not include marijuana-related convictions that occurred more than 2 years prior to the application date.)
 Yes  No * If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.)
Are you a veteran?
 Yes  No * If yes, dates of service:
Special skills or training:

Employment Information

Are you seeking full time, part time or temporary employment?
 Full Time  Part Time  Temporary * What hours and shift(s) would you prefer to work? *
List times you are not available to work: *
Are you willing to work overtime?
 Yes  No * Weekends?
 Yes  No * Holidays?
 Yes  No * Are you currently employed?
 Yes  No * If hired, when would you be able to start?
Have you ever worked for this organization before?
 Yes  No * If yes, name used:
List any friends or relatives employed by this company:
Have you ever been discharged or asked to resign from any position?
 Yes  No * If yes, please describe:
If applicable, please refer to the attached job description for the position for which you are applying. Are you able to perform all these tasks with or without reasonable accommodation?
 Yes  No Please describe which tasks, if any, you will need accommodation to perform, and explain what type of accommodation you will need:

Education

Elementary:
 One  Two  Three  Four  Five  Six  Seven  Eight * Name of School:
Location of School:
Secondary:
 Nine  Ten  Eleven  Twelve  G.E.D. Name of School:
Location of School:
If in high school, are you enrolled in a recognized co-op program?
 Yes  No If yes, identify program and school:
College:
 One  Two  Three  Four  Five  Six  Seven  Eight Name of School:
Location of School:
Degree & Major:
Minor:

Work History

(PLEASE BEGIN WITH MOST RECENT)

COMPANY #1

Company:
Phone No. with Area Code:
Address:
City:
State:
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   Zip:

DATES OF EMPLOYMENT

Start Date:
End Date:

SALARY

Starting:
Ending:
Job Title:
Supervisor’s Name & Title:
Describe duties briefly:
Specific Reason for Leaving:

COMPANY #2

Company:
Phone No. with Area Code:
Address:
City:
State:
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   Zip:

DATES OF EMPLOYMENT

Start Date:
End Date:

SALARY

Starting:
Ending:
Job Title:
Supervisor’s Name & Title:
Describe duties briefly:
Specific Reason for Leaving:

COMPANY #3

Company:
Phone No. with Area Code:
Address:
City:
State:
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   Zip:

DATES OF EMPLOYMENT

Start Date:
End Date:

SALARY

Starting:
Ending:
Job Title:
Supervisor’s Name & Title:
Describe duties briefly:
Specific Reason for Leaving:

COMPANY #4

Company:
Phone No. with Area Code:
Address:
City:
State:
   Alabama  Alaska  Arizona  Arkansas  California  Colorado  Connecticut  Delaware  Florida  Georgia  Hawaii  Idaho  Illinois  Indiana  Iowa  Kansas  Kentucky  Louisiana  Maine  Maryland  Massachusetts  Michigan  Minnesota  Mississippi  Missouri  Montana  Nebraska  Nevada  New Hampshire  New Jersey  New Mexico  New York  North Carolina  North Dakota  Ohio  Oklahoma  Oregon,  Pennsylvania  Rhode Island  South Carolina  South Dakota  Tennessee  Texas  Utah  Vermont  Virginia  Washington  West Virginia  Wisconsin  Wyoming   Zip:

DATES OF EMPLOYMENT

Start Date:
End Date:

SALARY

Starting:
Ending:
Job Title:
Supervisor’s Name & Title:
Describe duties briefly:
Specific Reason for Leaving:

Authorizations & At-Will Employment Agreement

(PLEASE READ CAREFULLY, THEN SIGN AND DATE BELOW) I CERTIFY THAT I HAVE PERSONALLY COMPLETED THIS APPLICATION. I DECLARE THAT THE INFORMATION PROVIDED IN THIS EMPLOYMENT APPLICATION IS TRUE AND COMPLETE AND I UNDERSTAND THAT ANY FALSE INFORMATION OR SIGNIFICANT OMISSIONS MAY DISQUALIFY ME FROM FURTHER CONSIDERATION FOR EMPLOYMENT AND MAY BE JUSTIFICATION FOR MY DISMISSAL FROM EMPLOYMENT IF DISCOVERED AT A LATER DATE. I AGREE TO IMMEDIATELY NOTIFY THIS COMPANY IF I SHOULD BE CONVICTED OF A CRIME WHILE MY JOB APPLICATION IS PENDING OR DURING MY EMPLOYMENT, IF HIRED. I AUTHORIZE THIS COMPANY TO MAKE AN INVESTIGATION OF ALL INFORMATION CONTAINED IN THIS EMPLOYMENT APPLICATION AND I RELEASE FROM LIABILITY ALL COMPANIES AND CORPORATIONS SUPPLYING SUCH INFORMATION. I UNDERSTAND ANY FALSE ANSWERS, STATEMENTS, OR IMPLICATIONS MADE BY ME ON THIS APPLICATION OR OTHER REQUIRED DOCUMENTS SHALL BE CONSIDERED SUFFICIENT CAUSE FOR DENIAL OF EMPLOYMENT OR DISCHARGE. I SPECIFICALLY AUTHORIZE AND DIRECT MY CURRENT AND FORMER EMPLOYERS TO SUPPLY EMPLOYMENT-RELATED INFORMATION TO THIS COMPANY AND DO HEREBY RELEASE MY CURRENT AND FORMER EMPLOYERS FROM LIABILITY FOR PROVIDING INFORMATION TO THIS COMPANY. UPON TERMINATION OF MY EMPLOYMENT FOR WHATEVER REASON, I RELEASE THIS COMPANY FROM ALL LIABILITY FOR SUPPLYING ANY INFORMATION CONCERNING MY EMPLOYMENT TO ANY POTENTIAL EMPLOYER. I AUTHORIZE THIS COMPANY, IF APPLICABLE, TO REQUEST A COPY OF MY CREDIT REPORT, MOTOR VEHICLE DRIVING RECORD, AND ANY OTHER INVESTIGATIVE REPORT DEEMED NECESSARY THROUGH VARIOUS THIRD PARTY SOURCES. AS REQUIRED BY LAW, UPON REQUEST WITHIN A REASONABLE PERIOD OF TIME, I WILL BE NOTIFIED AS TO THE NATURE AND SCOPE OF SUCH INVESTIGATIONS. I HEREBY AGREE TO SUBMIT TO ANY DRUG TEST REQUIRED OF ME, WHETHER PRIOR TO MY EMPLOYMENT OR IF EMPLOYED BY THIS COMPANY AT ANY TIME THEREAFTER. IF REQUESTED, I WILL TAKE A POST-JOB OFFER PHYSICAL EXAMINATION AND MY EMPLOYMENT, IN THE EVENT I RECEIVE MEDICAL TREATMENT FOR ANY CONDITION, INCLUDING A PHYSICAL, PSYCHOLOGICAL, EMOTIONAL, OR PSYCHIATRIC CONDITION THAT IS JOB-RELATED, I HEREBY AUTHORIZE THE LIMITED RELEASE AND EXCHANGE OF SUCH MEDICAL INFORMATION RELATING TO MY CONDITION BETWEEN THE TREATMENT PROVIDER AND A COMPANY-DESIGNATED PHYSICIAN.

AT-WILL EMPLOYMENT AGREEMENT

I UNDERSTAND AND AGREE THAT NOTHING CONTAINED IN THIS APPLICATION, OR CONVEYED DURING ANY INTERVIEW IS INTENDED TO CREATE AN EMPLOYMENT CONTRACT BETWEEN THE COMPANY AND ME. IN ADDITION, I UNDERSTAND AND AGREE THAT IF YOU EMPLOY ME, IN CONSIDERATION OF MY EMPLOYMENT, MY EMPLOYMENT AND COMPENSATION WILL BE AT-WILL, FOR NO DEFINITE PERIOD OF TIME, AND MAY BE TERMINATED AT ANY TIME, FOR ANY REASON, OR FOR NO REASON AT ALL. I UNDERSTAND THAT ONLY THE COMPANY’S PRESIDENT IS AUTHORIZED TO CHANGE THE EMPLOYMENT-AT-WILL STATUS AND SUCH A CHANGE CAN ONLY BE DONE IN WRITING. I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE.

Name:
Date:

This field is present to prevent automated submission systems. If you see it, please do not fill in a value.