Employment Application

Personal Information:

Name
Home Phone:
Cell Phone:
Address

Are you legally authorized to work in the US?
Yes No
Are you below the age of 18?
Yes No
Have you previously been employed by this company or its subsidiaries?
Yes No
Are you related to anyone in our employ?
Yes No
Have you previously applied for employment here?
Yes No
Have you ever been convicted of a felony?
Yes No

Employment Desired:

Position:
Date Available to Start:
Are you currently employed?
Yes No
Do you wish to work:
Full Time Temporary Part Time

Availability: What hours are you AVAILABLE to work?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

EDUCATIONAL INFORMATION:

School Print Name, Street Address, City, State, & Zip Code for each school # of Years Attended Degree Type
Dates Attended
High School
College
Graduate School
Trade/Other (Specify)

EMPLOYMENT HISTORY

Please list all employers, Present or most recent first

Employment #1

Employment Dates:
from
to
Employer:
Employer Address:
Supervisor's Name:
Supervisor's Phone:
Job Title:
Ending Salary:
May We Contact?
Yes No
Job Responsibilities
Reason for Leaving

Employment #2

Employment Dates:
from
to
Employer:
Employer Address:
Supervisor's Name:
Supervisor's Phone:
Job Title:
Ending Salary:
May We Contact?
Yes No
Job Responsibilities
Reason for Leaving

REFERENCES:

(List 3 or more persons who are NOT employers or relative and whom you have known at least 1 year)
Name and Address Occupation Phone Number

Do you know any reasons why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation?
Yes No

AGREEMENT: (Please read the following statements carefully)

I hereby affirm that the information provided on this application (and the accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I understand that my employment can be terminated, with or without cause, at any time at the discretion of either the company or myself. I understand that no management official, other than the President of the company has any authority to enter into any agreement contrary to the foregoing or make any oral or written assurances or promises of continued employment.

I hereby authorize this company to contact any persons, schools, current employers (if applicable), previous employers and organizations or references named in this application (and accompanying resume, if any) to provide relevant information deems appropriate to investigate my history, character and qualifications to arrive at any employment decision and I hereby give my full and complete consent to their revealing any and all information they wish as a result of said investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation of character, invasion of privacy or any other reason because of their statements.

Please enter your initials to agree to the terms above.

Pre-Employment Inquiry Release Form

In connection with my application for employment with Tony Roni’s, I understand that investigative background inquiries are to be made on myself including financial, criminal, driving history, previous employment and other reports. These reports will include information pertaining to my character, work habits, performance, and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from various federal, state, and other agencies which records concerning my past activities relating to my driving, credit, criminal, civil, academic, and other experiences as well as claims involving me in the fields of insurance companies.

I also understand that Tony Roni’s has the right to rescind an offer of employment, if an offer has been extended as well as the right to terminate employment based in whole or part on one or more consumer reports compiled and furnished by EMPLOYEE SCRENING SERVICES.

I authorize without reservation, any service or agency contacted by this employer to furnish the abovementioned information.

I hereby consent to your obtaining the above information from EMPLOYEE SCREENING SERVICES and/or any of their licensed agents.

Print Your Name:
 Enter in Your Current Address
Enter In your Initials
 Release Form Date (today's date)