Application for Employment

Name:

First NameLast Name

"Preferred Name":

The name you wish for us to call you.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Do you have reliable transportation to work?

What wage rate are you expecting?

Type a dollar amount

Are you younger than 18 years old?

If hired, can you provide verification of your legal right to work in the U.S.?

Have you ever been convicted of a felony? (Please do not answer YES or provide any information about convictions that have been erased, expunged, sealed, set aside, vacated, annulled or otherwise eradicated by a court of law. Failure to answer this question accurately could cause denial of employment or termination of employment).

Availability

Rows	Start	End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Are you looking for seasonal work (just summer time) or a permanent position?

Are you looking Full or Part time?

MINIMUM # of hours needed to work

15, 20, etc.

MAXIMUM # of hours needed to work

30, 40, etc.

Have you ever worked for Chick-fil-A, Inc or for a Chick-fil-A franchisee?

1. Name and address of MOST RECENT employer:

Street Address

CityState / Province

Postal / Zip Code

Supervisor's Name:

Beginning Employment Date:

Date

Ending Employment Date:

Date

Please tell us your last wage rate:

Reason for Leaving:

Most Recent Employer's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

2. Name and address of a PREVIOUS employer:

Employer Name

Street Address

CityState / Province

Postal / Zip Code

Supervisor's Name:

Beginning Employment Date:

Date

Ending Employment Date:

Date

Please tell us your last wage rate:

Reason for Leaving:

Employer's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

3. Name and address of another PREVIOUS employer:

Employer Name

Street Address

CityState / Province

Postal / Zip Code

Supervisor's Name:

Beginning Employment Date:

Date

Ending Employment Date:

Date

Please tell us your last wage rate:

Reason for Leaving:

Employer's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Last High School Attended:

Graduate?

College and Vocational Schools Attended:

Year Graduated:

Please list job-related award and/or leadership positions held (work or school) below:

Reference #1

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Reference # 2

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Reference # 3

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

I understand that I am applying for employment at this Chick-fil-A restaurant location only and this location is operated by an indeenbdent franchisee (ther "Franchisee").

I further understand that completion of this application does not indicate there are any positions currently open and does bot obligate the Franchisee to hire me.

I certify that all of the answers given in this application are true and complete to the best of my knowledge and that I have personally completed this application.

I understand that providing false or misleading information or omitting pertinent information in my application or a job interview shall be grounds for rejectiojn or for immediate dischage if I am employed.

I understand that if I am employed, my employment will be for no defiinite period of time. I undertand that my employment may be terminated at will with or without cause, and with or without notice, at the option of either the Franchisee or me.

I authorize all persons or business contacted by or on behalf of the Franchisee about me or my application to disclose any and all performance reviews, reports or other documents and information related to my background, work history and qualifications, with or without me giving prior written notice of such disclosure. I also authorize persons named herein as references and others of whom the Franchisee may inquire about my background to provide the Franchisee with my pertinent information they may have regarding me. By signing below, I fully release the Franchisee, my former employers and all other pesons and businesses from any and all claims, demands or liabilities arising out of or in any way related to such references or disclosures.

Please sign below

Signature

Application for Employment

Personal Information

Previous Employment History

Previous Employment Information

Education

Personal Background

References

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY