How long _____________________ Social Security No. _______ – _____ – _________
Telephone Cellular Phone _
Position applied for Full Time, which means available 24 hours a day, but would have part-time hours Part-time and available only during certain hours of the day
Please specify the hours you would be available to work if you chose the part-time position:
Mon ___________ Fri ____________
Tue ___________ Sat ____________ Wed ___________ Sun ____________ Thurs ___________ Any additional time restrictions, please explain
____________________________________________________________________________________________________ PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE APPLICATION FOR EMPLOYMENT
DO YOU HAVE A VALID DRIVER’S LICENSE? Yes No
What is your means of transportation to work? __________________________________________ Driver’s license number ________________ State of issue _____ Operator Commercial (CDL) Chauffeur
Expiration date _______________
Have you had any accidents during the past three years? Yes No How many? _____________ Have you had any moving violations during the past three years? Yes No
How many? _____________
Do you have vehicle insurance Yes No
Certificate of Insurance from your insurance company showing minimum liability amounts of 100,000/300,000/100,000 must be shown upon hiring. Are you able to provide this certificate with these liability limits? Yes No
Please list two personal references other than relatives or previous employers.
Name _________________________________ Name ____________________________________
Position _______________________________ Position __________________________________ Company ______________________________ Company _________________________________ Address _______________________________ Address __________________________________ ________________________________ ____________________________________ Telephone Telephone
An application form sometimes makes it difficult for an individual to adequately summarize a
complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. ____________________________________________________________________________________________________
____________________________________________________________________________________________________ PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE APPLICATION FOR EMPLOYMENT
MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES? Yes No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? Yes No Specialty ___________________________ Date Entered ____________ Discharge Date __________
Work Experience
Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer Name of last Employment Pay or salary
supervisor dates Address City, State, Zip Code From Start Phone number To Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer Name of last Employment Pay or salary
supervisor dates Address City, State, Zip Code From Start Phone number To Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE APPLICATION FOR EMPLOYMENT
Work experience, Continued
Name of employer Name of last Employment Pay or salary
supervisor dates Address City, State, Zip Code From Start Phone number To Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer Name of last Employment Pay or salary
supervisor dates Address City, State, Zip Code From Start Phone number To Final
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact your present employer? Yes No
Did you complete this application yourself Yes No If not, who did? _____________________________________________________________________ Please provide a list of at least 3 work references, name & phone number, who could attest to your work ethic and moral character.
In exchange for the consideration of my job application by Checkers, Inc. (hereinafter called “the Company”), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, drug & alcohol policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Checkers, Inc., or otherwise to change in any respect the employment-at- will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the owners of the Company. Both the undersigned and Checkers, Inc., may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their policies and procedures. Initial & Date________________ I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. Initial & Date __________________ I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. Initial & Date __________________ I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative background check including information as to my credit records, motor vehicle records, and character, general reputation, and personal characteristics. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. Initial & Date __________________
Signature of applicant ______________________________ Date: _______________
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
Thank you for completing this application form and for your interest in our business.
