Sample Employment Application Form - Checkers® - Home

1 Checkers, Inc. Employment Application FormPLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATUREAPPLICATION FOR EMPLOYMENTAPPLICANTS WILL BE TESTED FOR ILLEGAL DRUGS AND ALCOHOLPLEASE COMPLETE ALL _____Name _____Last First Middle MaidenPresent address _____ Address City State ZipHow 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.

2 Mon _____ Fri _____Tue _____ Sat _____Wed _____ Sun _____Thurs _____Any additional time restrictions, please explain _____ TYPE OF SCHOOL NAME OF SCHOOLLOCATION(Complete mailing address)NUMBER OF YEARS COMPLETEDMAJOR & DEGREEHigh SchoolCollegeBus. or Trade SchoolProfessional SchoolHAVE YOU EVER BEEN CONVICTED OF A CRIME? No YesIf yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

3 _____PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATUREAPPLICATION 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.

4 Are you able to provide this certificate with these liability limits? Yes NoPlease list two personal references other than relatives or previous _____ 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 PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATUREAPPLICATION FOR EMPLOYMENTMILITARYHAVE YOU EVER BEEN IN THE ARMED FORCES?

5 Yes NoARE YOU NOW A MEMBER OF THE NATIONAL GUARD? Yes NoSpecialty _____ Date Entered _____ Discharge Date _____ Work ExperiencePlease list your work experience for the past five years beginning with your most recent job you were self-employed, give firm name. Attach additional sheets if of employer AddressName of last supervisorEmployment datesPay or salaryCity, State, Zip CodePhone numberFromToStartFinalYour last job titleReason for leaving (be specific)List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

6 Name of employer AddressName of last supervisorEmployment datesPay or salaryCity, State, Zip CodePhone numberFromToStartFinalYour last job titleReason for leaving (be specific)List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

7 PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATUREAPPLICATION FOR Employment Work experience, ContinuedName of employer AddressName of last supervisorEmployment datesPay or salaryCity, State, Zip CodePhone numberFromToStartFinalYour last job titleReason for leaving (be specific)List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

8 Name of employer AddressName of last supervisorEmployment datesPay or salaryCity, State, Zip CodePhone numberFromToStartFinalYour last job titleReason for leaving (be specific)List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

9 May we contact your present employer?

10 Yes NoDid you complete this Application yourself Yes NoIf 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. READ CAREFULLYAPPLICATION form WAIVERIn 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.