APPLICATION FOR EMPLOYMENT @ KITH KITCHENS

FULL NAME (FIRST MIDDLE LAST) *

EMPLOYEE NUMBER

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

HOME TELEPHONE *

CELL PHONE *

EMAIL ADDRESS

example@example.com

POSITION APPLYING FOR: *

ARE ANY OF YOUR RELATIVES PRESENTLY EMPLOYED WITH THE COMPANY OR ITS DIVISIONS?

Yes No

IF YES ABOVE, NAME OF RELATIVE:

HAVE YOU EVER APPLIED FOR OR WORKED FOR THE COMPANY OR ITS DIVISIONS BEFORE? *

Yes No

IF YES, WHERE OR WHEN? APPROXIMATE DATE: MO/YR.

Date

HOW WERE YOU REFERRED: *

ARE YOU UNDER AGE 18? *

Yes No

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

Yes No

IF YES, PLEASE EXPLAIN:

(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. FACTORS SUCH AS JOB RELATIONS, AGE AND TIME OF THE OFFENSE, SERIOUSNESS AND NATURE OF VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT)

HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT OR ASKED TO RESIGN? *

Yes No

IF YES, PLEASE EXPLAIN:

[ ] I am available and desire to work FULL-TIME (40 hours) and do not have restrictions on my hours and days. (Complete Section B.) [ ] I am available and desire to work PART-TIME (If less than 40 hours a week, please complete Sections A & B

I am available and desire to work FULL-TIME (40 hours) and do not have restrictions on my hours and days. (Complete Section B.) I am available and desire to work PART-TIME (If less than 40 hours a week, please complete Sections A & B *

Full-Time Part-Time

SECTION A. I am only available for PART-TIME because: Student, Other Job, Other (explain)

SECTION B. PART-TIME DAYS AVAILABLE FROM

List Available Days i.e.(Monday-Sunday)

SECTION B. PART-TIME DAYS AVAILABLE TO

List Available Hours of the day.

NOTE: WORK SCHEDULES ARE BASED UPON THE NEEDS OF THE BUSINESS AND MAY BE SUBJECT TO CHANGE ON A WEEKLY BASIS.

WAGE EXPECTED *

DATE AVAILABLE FOR WORK? *

Date

BEGIN WITH YOUR MOST RECENT EMPLOYMENT [1] AND CONTINUE WITH ALL PAST EMPLOYMENT

NAME OF COMPANY *

TYPE OF BUSINESS *

ADDRESS *

CITY, STATE, ZIP *

PHONE NO. *

DATES WORKED FROM / TO *

JOB TITLE *

STARTING SALARY *

ENDING SALARY *

DESCRIBE JOB DUTIES *

REASON FOR LEAVING *

NAME & TITLE OF IMMEDIATE SUPERVISOR *

EXPLAIN ANY PERIOD BETWEEN JOBS *

MAY WE CONTACT EMPLOYER? *

Yes No

NAME OF COMPANY

TYPE OF BUSINESS

ADDRESS

CITY, STATE, ZIP

PHONE NO.

DATES WORKED FROM / TO

JOB TITLE

STARTING SALARY

ENDING SALARY

DESCRIBE JOB DUTIES

REASON FOR LEAVING

NAME & TITLE OF IMMEDIATE SUPERVISOR

EXPLAIN ANY PERIOD BETWEEN JOBS

MAY WE CONTACT EMPLOYER?

Yes No

NAME OF COMPANY

TYPE OF BUSINESS

ADDRESS

CITY, STATE, ZIP

PHONE NO.

DATES WORKED FROM / TO

JOB TITLE

STARTING SALARY

ENDING SALARY

DESCRIBE YOUR JOB DUTIES

REASON FOR LEAVING

NAME & TITLE OF IMMEDIATE SUPERVISOR

EXPLAIN ANY PERIOD BETWEEN JOBS

MAY WE CONTACT EMPLOYER?

Yes No

NAME OF COMPANY

TYPE OF BUSINESS

ADDRESS

CITY, STATE, ZIP

PHONE NO.

DATES WORKED FROM / TO

JOB TITLE

STARTING SALARY

ENDING SALARY

DESCRIBE YOUR JOB DUTIES

REASON FOR LEAVING

NAME & TITLE OF IMMEDIATE SUPERVISOR

EXPLAIN ANY PERIOD BETWEEN JOBS

MAY WE CONTACT EMPLOYER?

Yes No

HIGH SCHOOL *

Name and Address

LAST YEAR COMPLETED *

GRADUATED *

DEGREE *

Type of Degree

COLLEGE *

Name and Address

LAST YEAR COMPLETED

GRADUATED

DEGREE

Type of Degree

COLLEGE

Name and Address

LAST YEAR COMPLETED

GRADUATED

DEGREE

Type of Degree

GRADUATE SCHOOL

Name and Address

LAST YEAR COMPLETED

GRADUATED

DEGREE

Type of Degree

BUSINESS. TRADE OTHER

Name and Address

LAST YEAR COMPLETED

GRADUATED

DEGREE

Type of Degree

List any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment. *

NAME *

OCCUPATION BUSINESS PHONE *

HOME ADDRESS HOME PHONE *

TITLE RELATIONSHIP *

CITY AND STATE (ZIP) *

HOW LONG KNOWN? *

NAME

OCCUPATION BUSINESS PHONE

HOME ADDRESS HOME PHONE

TITLE RELATIONSHIP

CITY AND STATE (ZIP)

HOW LONG KNOWN

I CERTIFY THAT ALL ANSWERS GIVEN BY ME ARE TRUE, ACCURATE AND COMPLETE, I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT ON THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR H0W DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me, I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company and all Plan Administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President or Executive Vice President, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

APPLICANT SIGNATURE *

Clear

APPLICANT SIGNATURE *

DATE *

Date

Include Resume attachment

APPLICATION FOR EMPLOYMENT WITH KITH KITCHENS

PERSONAL INFORMATION

GENERAL INFORMATION

PLEASE CHECK SCHEDULE AVAILABILITY:

EMPLOYMENT HISTORY

PREVIOUS EMPLOYER 1

PREVIOUS EMPLOYER 2

PREVIOUS EMPLOYER 3

PREVIOUS EMPLOYER 4

EDUCATION

ADDITIONAL EXPERIENCE OR QUALIFICATIONS

PERSONAL OR BUSINESS REFERENCES

NOTIFICATION AND AGREEMENT