Employment
Contact Information
Name:
Street:
City:
State/Province:
Zip/Postal Code:
Phone:
Email:

Requested Information
Are you at least 16?
Social Security Number
What position are you applying for?
What is your salary requirement (if any)?
Number of hours desired:
Are you currently employed?
Current Position
May we inquire of your present employer?
Have you ever applied to this company before?
If so, when and for what position?
Are there any days you are not available?
Please list the shifts you can NOT work each day Monday through Sunday? (Open: 8am-11am | Mid: 11am-4pm | Close: 4pm-11pm)
Please list the name & location of each school you attended, the years attended and if you graduated
Please list any special training, skills, or military service
Please list your last four employers, their location, the dates you were employed, your position, and reason for leaving
Reference #1: Please list name, position, years known, and a phone number where we may contact this person
Reference #2: Please list name, position, years known, and a phone number where we may contact this person
Reference #3: Please list name, position, years known, and a phone number where we may contact this person
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 By submitting this application form 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 statements on this application shall be grounds for dismissal.                
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 understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.                
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disability Act (ADA) and other relevant federal and state laws.                
I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment."                
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required remployment eligibility verification document form upon hire.