Brickyard Job Application

Employment Application

Pre-Employment Questionnaire Equal Opportunity Employer
Personal Information
Date

Month Day Year
Date
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area Code Phone Number
Referred By:
Position (Check all that apply):

Prep Cook/Cook/Caterer

Education History

List High School:
High School *
Did You Graduate? *
College
Did You Graduate

Former Employers

List below last four employers, started with the most current.
Company Name: *
Dates Employed: *
Reason Left: *
Company Name:
Dates Employed:
Reason Left:
Company Name:
Dates Employed:
Reason Left:
Company Name:
Dates Employed:
Reason Left:
Resume/Cover Letter

Browse Files
Attach File Cancel of
References

Give below the names of three persons not related to you, whom you have known at least one year.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number

Authorization

*I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
*I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utiliztion of such information.

I also understand and agree that no represetative of the company has any authority to enter into any agreement for employement for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required eligibility verification document form upon hire.
Date *

Month Day Year
Date
Should be Empty:

Employment Application

Education History

Former Employers

References

Authorization