Restaurant Application Form Prime

Application for Employment
Full Name*

First NameMiddle InitialLast Name
Phone Number*

Area CodePhone Number
E-mail*
Position Apply For
How did you find out about this opening?
If referred to this opening, who were you referred by?
Why are you seeking a new opportunity at this time?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If hired, do you have reliable transportation to get to work?

YesNo
Are you at least 18 years old?

YesNo
Available start date:*

MonthDayYear
Are you legally eligible for employment in the U.S.? (Proof of U.S. citizenship or immigration status is required if hired.)

YesNo
Have you previously been employed at David Burke Prime or Caputo Trattoria?

YesNo
If yes, under what name was your employment record?
If yes, Which Restaurant?
Are you eligible for rehire?

YesNo
Are you a veteran?

YesNo
List any special skills or training
(For kitchen / cook/ prep-cook / pastry applicant) If hired, you may be required to provide a personal hand tool. Would you be able to provide basic personal hand tools, e.g. knives?

YesNo
Employment Information
Are you seeking:

Full Time EmploymentPart Time EmploymentTemporary Employment
What is your hourly rate/salary desired for this position

Availability, Check the shifts you are available

Rows	AM	PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Are you willing to work overtime?

YesNo
Weekends?

YesNo
Holidays?

YesNo
Are you currently Employed?

YesNo
If Hired, when would you be able to start?
Education:
Are you a High School Graduate?

YesNo
High School Equivalency?

YesNo
Are you presently attending school?

YesNo
What is your highest level of education attained?
Name of School?
Location of School?
Degree and Major
Minor
Employment History

Beginning with your present or most recent experience, account for all employment during the past ten (10) years. To elaborate, asupplemental sheet or resume may be attached, but cannot be substituted for a completed application. Include military service ifapplicable.
Name of Employer:
Job Title:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor:
Date started

MonthDayYear
Date ended

MonthDayYear
Reason for Leaving:
Description of Duties:
Do you have additional employers to enter?

YesNo
Name of Employer:
Job Title:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor:
Date started

MonthDayYear
Date ended

MonthDayYear
Reason for Leaving:
Description of Duties:
Do you have additional employers to enter?

YesNo
Name of Employer:
Job Title:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Supervisor:
Date started

MonthDayYear
Date ended

MonthDayYear
Reason for Leaving:
Description of Duties:
Inquiry may be made of your current and former employers/schools you attended.
May we contact your present employer?

YesNo
Personal References
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business or Occupation
Phone Number

Area CodePhone Number
Upload Resume

Upload a File

Cancelof
Authorizations & At-Will Employment Agreement

Please read carefully, then sign below
Authorizations & At-Will Employment Agreement
(please read carefully, then sign and date below)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or omissions may disqualify me from further consider-ation for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to imme-diately notify this company if I should be convicted of a crime either after my initial employment offer or while working for the company.

I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.
Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.

Root2 LLC is an equal opportunity employer. It does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, military status, physical or mental disability. I acknowledge that during the application process I was not asked about past earning history and I am aware it is not required of me to release this information at any time during the interviewing process.

AUTHORIZATION FOR BACKGROUND / CREDIT CHECK
I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources and understand that this will be completed after a initial employment offer has been made. I hereby agree to submit to any drug test required of me, prior to my employment or if employed by this company at any time thereafter. As required by law, upon request within a reason-able period of time, I will be notified as to the nature and scope of such investigations.

AT-WILL EMPLOYMENT AGREEMENT
I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an em- ployment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s CEO is authorized to change the employment-at- will status and such a change can only be done in writing. I have read, understand, and agree to the above.
Signature
Self Identification Form

For Native American Preference
This Form is provided to those applicants and employees who may or will be assigned to work on the Mashantucket Pequot Tribal Reservation (Reservation). If you are Native American, the information you provide may indicate your eligibility to receive preference in certain employment opportunities on the Reservation under the Mashantucket Pequot Tribal and Native American Preference Law, Title 33. For example, for many positions on the Reservation, an eligible applicant who meets the minimum necessary qualifications of the position receives preference in hiring.

Completing this form is voluntary. If you do not provide the requested information, you will not be eligible to be considered for preference opportunities, but you also will not be subjected to any adverse treatment. Neither this Self-Identification Form, nor its completion, guarantee employment or continued employment with the employer or assignment to work on the Reservation.

Please complete the questions below for consideration of benefit eligibility.
Your Name
Address
Are you a Native American?

YesNo
Are you a member of a tribe recognized by the Federal Government

YesNo
Do you live on or near a Native American Tribal Reservation?

YesNo
Are you enrolled or registered with your tribe?

YesNo
Name of Your Tribe
Address
Enrollment/Registration Number
Date of Birth
Signature
Date
You may be asked to present supporting documentation or information and it is your responsibility to establish evidence of entitlement to Native American preference.

The Preference Law requires employers to compile annual statistical reports relating to applicants for employment and employees. The information you provide will be used for Tribal law compliance and reporting purposes.

Mero Form-33-2500

(10-02-17)
Should be Empty:

Application for Employment

Employment Information

Education:

Employment History

Personal References

Authorizations & At-Will Employment Agreement

Self Identification Form