Application - Tick Tock Taco

EMPLOYMENT APPLICATION

This form is intended for use in evaluating your qualification for employment and it is not employment contract. Please answer all the questions completely to the best of your knowledge. False or misleading information are ground for refusal or termination of employment. Applicants are considered for employment without regard to national origin, age, disability, color, race, religion, veteran status, sexual orientation, citizenship or any other characteristics protected by law in all employment decision.

First Name

Middle Name

Last Name

Home Address

Apartment/Unit

State - Zip Code

Mailing Address

Apartment / Unit

State - Zip Code

Home Phone

Daytime (Work) Phone

Cell Phone

E-mail Address

Social Security Number

Date of Birth

May we contact you at work?

Yes No

Have you ever used other names during previous ten years? If yes please provide other name(s) and the date(s) they were used.

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Are you 18 years of age or older?

Yes No

Are you legally eligible for employment in this country? (Proof of eligibility will be required at the time of employment)

Yes No

Will you now or in future require sponsorship (H1-B visa for employment in US)?

Yes No

Do you have any obligation to current or former employers that could impact your ability to work in the position for which you have applied?

Yes No

If position requires driving please provide driver’s license information.

Driver’s License Number

State Issued

Country Issued

Class

Expiration Date

Please provide ten years of employment history starting from the most recent first.

CURRENT / PREVIOUS EMPLOYMENT

Company

Phone

Address

Supervisor

Job Title

Starting Salary ($)

Ending Salary ($)

From

Reason for Leaving

May we contact your current / previous supervisor for a reference?

Yes No

PREVIOUS EMPLOYMENT

Company

Phone

Address

Supervisor

Job Title

Starting Salary ($)

Ending Salary ($)

From

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

HIGH SCHOOL

Name

City

State

Country

Did you graduate?

Yes No

Degree Received?

Yes No

Major

COLLEGE / UNIVERSITY / TECHNICAL SCHOOL

Name

City

State

Country

Did you graduate?

Yes No

Degree Received?

Yes No

Attended from

Major

Minor

COLLEGE / UNIVERSITY / TECHNICAL SCHOOL

Name

City

State

Country

Did you graduate?

Yes No

Degree Received?

Yes No

Attended from

Major

Minor

REFERENCE 1

Full Name

Title

Company

Years known

City

State

Country

Daytime Phone

Alternate Phone

E-mail

REFERENCE 2

Full Name

Title

Company

Years known

City

State

Country

Daytime Phone

Alternate Phone

E-mail

REFERENCE 3

Full Name

Title

Company

Years known

City

State

Country

Daytime Phone

Alternate Phone

E-mail

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

CV/ Resume

Date