Ben & Jerry's Application for Employment

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Which location would you like to apply for?

Availability (Please check all that apply!)*

Rows	Day Shift 11-5	Mid Shift 1-7 2-9 3-10	Closing Shift A 4-10 5-10	Closing Shift B 5-11 5-12
Mon
Tues
Wed
Thur
Fri
Sat
Sun

When are you able to start employment with us?*

Date

Are you currently a student?*

YesNo

Please tell us about the school you're attending and what you're studying!*

Do you have prior work experience?*

YesNo

Job 1*

Tell us one thing you loved about this job, and one thing you wish was different!*

Do you have additional work experience TO ADD?*

YesNo

Job 2*

Tell us one thing you loved about this job, and one thing you wish was different!*

Do you have additional work experience TO ADD?*

YesNo

Job 3*

Tell us one thing you loved about this job, and one thing you wish was different!*

Have you ever worked for a Ben & Jerry's scoop Shop before?*

YesNo

Scoop Shop Location*

Do you have any foodservice experience?*

YesNo

Do you have any health problems of physical disabilities which could affect your employment?*

YesNo

Do you now have, or have you had within the last 6 months, any contagious or communicable diseases, gastro-intestinal infections, or have you ever had hepatitis or salmonella?*

YesNo

During the past seven years, have you ever been convicted of a crime, EXCLUDING misdemeanors and traffic violations? (Note: A conviction will NOT necessarily bar you from employment.)*

YesNo

Of all the places you could choose to work, why Ben & Jerry's?*

I certify that the information contained on this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with the policy of this independent Ben & Jerry's franchise. I authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I acknowledge that if I become employed, I will be free to terminate my employment at any time for any reason and this Ben & Jerry's franchise retains the same rights. No Ben & Jerry's representative of the Ben & Jerry's franchise has the authority to make any contrary agreement.*

Yes!

This Ben & Jerry's franchise is an equal opportunity employer. The Civil Rights Act of 1964 and State and Local laws prohibit discrimination on the basis of race, color, religion, sex, national origin, or veterans status. In addition, State and Local laws prohibit discrimination on the basis of disability and the Age Discrimination in Employment Act of 1978 and some State and Local laws prohibit discrimination on the basis of age with respect to individuals who are at least 40 years of age. It is our policy to comply fully with these Acts and information requested on this application will not be used for any purpose prohibited by law.*

Sign Here, Please!

YOUR APPLICATION WILL BE CONSIDERED ACTIVE FOR 30 DAYS-FOR CONSIDERATION AFTER THAT YOU MUST REAPPLY. THIS RESTAURANT IS OWNED AND OPERATED BY AN INDEPENDENT BEN & JERRY'S FRANCHISE.