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PERSONAL INFORMATION
Name *
Name
Present Address *
Present Address
Permanent Address (If different than above.)
Permanent Address (If different than above.)
Cell Phone *
Cell Phone
Home Phone
Home Phone
Are you over 18 years of age? *
Are you over 21 years of age? *
Are you currently authorized to work in the United States? *
(If hired, verification will be required by law.)
Have you ever pled "guilty", "no contest", or been convicted of a crime? *
Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness, and nature of the violation, rehabilitation and position applied for will be considered.
EMPLOYMENT DESIRED
Position Desired *
If you would like to be considered for more than one position, please check all those that apply.
Date You Can Start if Hired *
Date You Can Start if Hired
Are you currently employed? *
If so, would you need to provide your current employer with a 'two-week notice' if hired?
Days/Hours Available to Work *
Please check all that apply.
$
The U.S. Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, and campylobacter, may prevent you from serving good food or handling food equipment in a sanitary or healthy fashion. An essential function of this job involves serving food or handling food equipment in a sanitary and healthy fashion. Can you, with or without reasonable accommodation, perform this essential function of this job?
EDUCATION
High School
Did you graduate? *
College
Did you graduate?
EMPLOYMENT HISTORY
Please list past employers starting with the most recent.
Please Include Name & Address
Telephone *
Telephone
Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.
MM/YYYY of Hire - MM/YYYY of Departure
May we contact this employer? *
Please Include Name and Address
Telephone
Telephone
Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.
MM/YYYY of Hire - MM/YYYY of Departure
May we contact this employer?
Please Include Name and Address
Telephone
Telephone
Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.
MM/YYYY of Hire - MM/YYYY of Departure
May we contact this employer
Use the space below to add any additional past employment history you may have. Please include the information listed above for each former employer.
PERSONAL & PROFESSIONAL REFERENCES
Please include a minimum of one personal reference and one professional reference not related to you.
Reference # 1 *
Reference # 1
Phone *
Phone
Reference # 2 *
Reference # 2
Phone *
Phone
Reference # 3
Reference # 3
Phone
Phone
A FEW MORE QUESTIONS...
We want to get to know you a little bit better! Please answer the following questions to the best of your ability.
APPLICATION FORM WAIVER (PLEASE READ CAREFULLY)
IN EXCHANGE FOR THE CONSIDERATION OF MY JOB APPLICATION BY BRIXENS, LLC (HEREAFTER CALLED “THE COMPANY,”) I AGREE THAT: NEITHER THE ACCEPTANCE OF THIS APPLICATION NOR THE SUBSEQUENT ENTRY INTO ANY TYPE OF EMPLOYMENT RELATIONSHIP, EITHER IN THE POSITION APPLIED FOR OR ANY OTHER POSITION, AND REGARDLESS OF THE CONTENTS OF EMPLOYEE HANDBOOKS, PERSONNEL MANUALS, BENEFIT PLANS, POLICY STATEMENTS, AND THE LIKE AS THEY MAY EXIST FROM TIME TO TIME, OR OTHER COMPANY PRACTICES, SHALL SERVE TO CREATE AN ACTUAL OR IMPLIED CONTRACT OF EMPLOYMENT, OR TO CONFER ANY RIGHT TO REMAIN AN EMPLOYEE OF BRIXENS, LLC, OR OTHERWISE TO CHANGE IN ANY RESPECT THE EMPLOYMENT-AT-WILL RELATIONSHIP BETWEEN IT AND THE UNDERSIGNED, AND THAT RELATIONSHIP CANNOT BE ALTERED EXCEPT BY A WRITTEN INSTRUMENT SIGNED BY THE PRESIDENT/GENERAL MANAGER OF THE COMPANY. BOTH THE UNDERSIGNED AND BRIXENS, LLC MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITHOUT SPECIFIED NOTICE OR REASON. IF EMPLOYED, I UNDERSTAND THAT THE COMPANY MAY UNILATERALLY CHANGE OR REVISE THEIR BENEFITS, POLICIES, AND PROCEDURES AND SUCH CHANGES MAY INCLUDE REDUCTION IN OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL AT ANY TIME WITHOUT ANY PREVIOUS NOTICE. I HEREBY GIVE THE COMPANY PERMISSION TO CONTACT SCHOOLS, PREVIOUS EMPLOYERS, (UNLESS OTHERWISE INDICATED,) REFERENCES, AND OTHERS , AND HEREBY RELEASE THE COMPANY FOR ANY LIABILITY AS A RESULT OF SUCH CONTRACT. I ALSO UNDERSTAND THAT (1) THE COMPANY HAS A DRUG AND ALCHOHOL POLICY THAT MAY PROVIDE FOR PRE-EMPLOYMENT TESTING AS WELL AS TESTING AFTER EMPLOYMENT; (2) CONSENT TO AND COMPLIANCE WITH SUCH POLICY IS A CONDITION OF MY EMPLOYMENT, AND (3) CONTINUED EMPLOYMENT IS BASED ON THE SUCCESSFUL PASSING OF TESTING UNDER SUCH POLICY. I FURTHER UNDERSTAND THAT CONTINUED EMPLOYMENT MAY BE BASED ON THE SUCCESSFUL PASSING OF JOB-RELATED PHYSICAL EXAMINATIONS. I UNDERSTAND THAT, IN CONNECTION WITH THE ROUTINE PROCESSING OF THIS EMPLOYMENT APPLICATION, THE COMPANY MAY REQUEST FROM A CONSUMER REPORTING AGENCY AN INVESTIGATIVE CONSUMER REPORT INCLUDING INFORMATION AS TO MY CREDIT RECORDS, CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS, AND MODE OF LIVING. UPON WRITTEN REQUEST FROM ME, THE COMPANY, WILL PROVIDE ME WITH ADDITIONAL INFORMATION CONCERNING THE NATURE AND SCOPE OF ANY SUCH REPORT REQUESTED BY IT, AS REQUIRED BY THE FAIR CREDIT REPORTING ACT. I FURTHER UNDERSTAND THAT MY EMPLOYMENT WITH THE COMPANY SHALL BE PROBATIONARY FOR A PERIOD OF NINETY (90) DAYS, AND FURTHER THAT AT ANY TIME DURING THE PROBATIONARY PERIOD OR THEREAFTER, MY EMPLOYMENT RELATION WITH THE COMPANY IS TERMINABLE AT WILL FOR ANY REASON BY EITHER PARTY.
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.
Enter Electronic Signature
Today's Date *
Today's Date
THIS COMPANY IS AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER. WE ADHERE TO A POLICY OF MAKING EMPLOYMENT DECISIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, CITIZENSHIP, AGE OR DISABILITY. WE ASSURE YOU THAT YOUR OPPORTUNITY FOR EMPLOYMENT WITH THIS COMPANY DEPENDS SOLELY ON YOUR QUALIFICATIONS.