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Personal Information

Name:*

SSN:*

Date of Birth:*

Phone Number:*

Email:*

Address:*

City:*

State:*

Position Applying For*

Pay Expected

Position Desired:*

Will you work overtime if asked?*

Date you can start*

Are you willing to travel?*

Are you willing to relocate?*

Are you employed now?*

If yes, by whom?

Business phone for contact

May we contact you at work?*

.

Are you over the age of 18 years?*

If you answered NO, please provide your date of birth. (mm/dd/yyyy)

Availability

Mon

Tue

Wed

Thu

Fri

Sat

Sun

In Case of Emergency Notify

Name*

Relationship*

Phone Number*

Education

Name & Location of more recent school*

Degree/diploma or highest level of education:*

Other special training or skills (languages, machine operations, etc)

Legal

The existence of a criminal record will not automatically disqualify you from the job for which you are applying.

Are you legally able to be employed in this country?*

Did any company ever discharge you?*

If yes, give name of company(ies)

Reason for discharge

Have you ever been convicted of a crime other than a minor traffic violation?*

If yes, please explain offense and final disposition

U.S. Military Service

Branch of Service

Rank Attained

Technical Specialization

Type of Discharge

Chicken Express History

Have you ever applied or been employed by this Chicken Express or any other location(s)*

Location

Date of Employed

Position Held

Supervisor Name

Reason for Leaving

Employment

Please begin with present or most recent employer

1. Company Name*

1. Supervisor*

1. Address

1. Phone Number*

1. Hourly Pay/Salary*

1. Start Date*

1. End Date*

1. Job Title & Description*

1. Reason for Leaving*

Notes

2. Company Name

2. Supervisor

2. Address

2. Phone Number

2. Hourly Pay/Salary

2. Start Date

2. EndDate

2. Job Title & Description

2. Reason for Leaving

Notes

3. Company Name

3. Supervisor

3. Address

3. Phone Number

3. Hour Pay/ Salary

3. Start Date

3. End Date

3. Job Title & Description

3. Reason for Leaving

Notes

4. Company Name

4. Supervisor

4. Address

4. Phone Number

4. Hourly Pay/Salary

4. Start Date

4. End Date

4. Job Title & Description

4. Reason for Leaving

Notes

Please Initial

To all applicants: Chicken Express tries to maintain a Drug-Free workplace, thus there are policies in force to help achieve this. All applicants are required to take a drug test. There will be random testing during employment and failing a test will result in immediate dismissal.

This is to inform all applicants that if you are hired, we will give a 14 day working trial (which means 14 days worked per employee time card) to decide if the job is agreeable to either employee or employer, being either may terminate employment without further incident.

I understand that receipt of this application by Chicken Express does not imply employment and that this application and/or any other Chicken Express documents are not contracts of employment. I also understand that if hired, I will be required to abide by all rules and regulations of Chicken Express.

"I certify that the facts 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 employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have. I release all parties from all liability for any damage that may result from furnishing this information to you."

I further agree that I do not have an employment contract and that my employment can be terminated or modified with or without notice or cause at any time by the company or me.

Agreement

Signature*

Date*

Application for Employment

Chicken Express