Employment - Country Cottage Restaurant

Employment Form

Position(s) Applied for:

Date Applied

First Name

Last Name

Other Name(s)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone (If different)

Employer 1

Supervisor 1

Employer 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer 1 Phone

Dates Employed at Employer 1 (month/yr) To/From

Reason for Leaving Employer 1

Employer 1 Job Titles and Duties

Employer 2

Supervisor 2

May we contact Employer 2?

Yes

Employer 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer 2 Phone

Dates Employed at Employer 2 (month/yr) To/From

Employer 2 Job Titles and Duties

Reason for Leaving Employer 2

Employer 3

Supervisor 3

May we contact Employer 3

Yes

Employer 3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Employer 3 Phone

Dates Employed at Employer 3 (month/yr) To/From

Employer 3 Title and Duties

Reason For Leaving Employer 3

High School

High School Name

HS Years Completed

High School Completed?

Yes

High School Specialized Training, Skills, or Extra-Curricular Activities

College

College Name

College Years Completed

College Completed?

Yes

College Specialized Training, Skills, or Extra-Curricular Activities

Graduate/Professional School

Graduate/Professional School Name

Graduate/Professional School Years Completed

Graduate/Professional School Completed?

Yes

Graduate/Professional School Specialized Training, Skills, or Extra-Curricular Activities

Trade School

Trade School Name

Trade School Years Completed

Trade School Completed?

Yes

Trade School Specialized Training, Skills, or Extra-Curricular Activities

Some description about this section

On what date are you available to begin work?

On what days of the week, and during what hours are you available to work?

Are you available to work?

If hired, can you present evidence of your identity and legal right to work in this country?

Yes

If you have any friends or relatives employed by Ferlito Restaurants please list their name and your relationship to them below:

(PLEASE LIST THREE REFERENCES WE MAY CONTACT REGARDING YOUR EMPLOYMENT HISTORY/ CHARACTER)

Reference 1

R1 Name

R1 Relationship

R2 Contact Information

Reference 2

R2 Name

R2 Relationship

R3 Contact Information

Reference 3

R3 Name

R3 Relationship

R3 Contact Information

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION, *PLEASE READ CAREFULLY BEFORE SIGNING*

- I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate, and
complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.
- I understand that submission of an application does not guarantee an employment opportunity. I further understand that, should an offer of employment be extended by Ferlito Restaurants Inc. that such employment with Ferlito Restaurants Inc. is at-will, with no specified duration and may be terminated by either Ferlito Restaurants Inc. or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Ferlito Restaurants Inc. or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of Ferlito Restaurants Inc. except the Owner has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Owner of Ferlito Restaurants Inc.
- I understand that if offered a position with Ferlito Restaurants Inc., I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory result from, refusal to cooperate with, or any attempt to affect the results of these pre-employments tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.
- I hereby authorize any and all schools, former employers, references, courts, and any others who have information about me to provide such information to
Ferlito Restaurants Inc. and/or any of its representatives, agents or vendors.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ABOVE STATEMENTS.

Type your full name:

Todays Date

Name and number of person completing this form if other than applicant: