Columbus Day News

DICK’S WINGS EXPRESS APPLICATION FOR EMPLOYMENT We are an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process. APPLICANTS MUST BE 16 YEARS OF AGE OR OLDER. INSTRUCTIONS: Please complete ALL sections of this application. Resumes may be attached as a supplement, but not as a replacement to completing this application. PERSONAL INFORMATION Name __________________________________________________________________________________________________ Last First Middle Initial Present Address ________________________________________________________________________________________ Street City State Zip Code Permanent Address ______________________________________________________________________________________ Street City State Zip Code Phone Number ___________________________________________ Alternate Phone Number __________________________ E-mail Address __________________________________________________________________________________________ Are you legally eligible for employment in the United States? ☐ Yes ☐ No If hired, can you submit verification of your legal right to work in the United States? ☐ Yes ☐ No Have you ever filed an application with us before? ☐ Yes ☐ No If yes, give date __________________________ Do any of your relatives work for this company? ☐ Yes ☐ No If yes, name(s) __________________________ Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation? ☐ Yes ☐ No Are you currently employed? ☐ Yes ☐ No May we contact your current employer? ☐ Yes ☐ No If no, when would you be available for work? _____________________________________________________________________________________________________ POSITION Position(s) applying for ____________________________________________________________Desired Salary ______________ Are you available to work: ☐ Full Time ☐ Part-Time ☐ Shift Work ☐ Weekends ☐ Overtime ☐ Evenings What days are you available to work? ☐ Sunday ☐ Monday ☐ Tuesday ☐ Wednesday ☐ Thursday ☐ Friday ☐ Saturday EDUCATION School Name Location Degree/Diploma Received Year Completed High School College Other MILITARY Branch of Service Type of Training Date Entered Date Discharged EMPLOYMENT HISTORY (List below last four employers, starting with the most recent one. Include summer and part-time jobs.) Employer Name & Address Dates Employed Position Held Reason for Leaving Phone Number Supervisor Name May we contact? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Employer Name & Address Dates Employed Position Held Reason for Leaving Phone Number Supervisor Name May we contact? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Employer Name & Address Dates Employed Position Held Reason for Leaving Phone Number Supervisor Name May we contact? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Employer Name & Address Dates Employed Position Held Reason for Leaving Phone Number Supervisor Name May we contact? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No REFERENCES (Give the names of three persons not related to you, whom you have known at least one year.) Full Name Occupation Years Known Phone Number Address Full Name Occupation Years Known Phone Number Address Full Name Occupation Years Known Phone Number Address BACKGROUND CHECK AUTHORIZATION I hereby authorize Dick’s Wings Express to conduct background checks as deemed necessary for employment purposes. Signature ______________________________________________________________ Date ____________________________ APPLICANT – PLEASE READ CAREFULLY BEFORE SIGNING I certify that all information I have provided in this application is true, correct and complete. I understand that any false statement, misrepresentation or omission of fact on this application or any other required document automatically disqualifies me from consideration for employment or, if employed, results in immediate dismissal. I authorize Dick’s Wings Express to verify any information contained in this application and to make investigations of my personal or employment history through any investigative agency or bureau and to contact any persons or organizations for the purpose of obtaining such information. I further authorize all former employers, persons, schools, companies, corporations, credit agencies and law enforcement agencies to supply Dick’s Wings Express with any information concerning my background. I specifically waive any requirement of written notice from any former or current employer or agency that it is providing information to Dick’s Wings Express. Additionally, I release Dick’s Wings Express and any person or firm providing information from all liability for any damages resulting from the furnishing or use of this information. I understand that if I am hired, I will be required to provide documentation verifying my identity and eligibility to work in the United States as required by federal law, and that my employment with Dick’s Wings Express is “at will,” which means that either Dick’s Wings Express or I may terminate the employment relationship at any time, with or without cause or notice. I further understand that such “at will” employment may only be changed in writing in a document signed by the President of Dick’s Wings Express. Signature ______________________________________________________________ Date ____________________________