Employment Application

APPLICATION FOR EMPLOYMENT

WE ARE AN EQUAL OPPORTUNITY EMPLOYER DEDICATED TO A POLICY OF NON-DESCRIMITION IN EMPLOYMENT ON ANY BASIS, INCLUDING RACE COLOR, AGE, RELIGION, SEX, NATIONAL ORIGIN, HANDICAP, DISABILITY, MARITAL STATUS OR VETERAN STATUS

PERSONAL DATA

Today’s Date:
First Name:
Middle Name:
Last Name:
Address:
Phone Number:
-
Have you worked under other names?:*
If yes, what name(s)?:
Have you ever worked for Fresh Grill.LLC or its affiliates before?:*
How did you hear about us?:*
If friend, what name?:

If related to anyone who works for this company, please state the following:

Persons's name:
Department:
Relationship:
Position Applying For:*
Date Available to Start:*
Salary Desired:*
Have you ever applied to this company before?:
If Yes, When:
Are you applying for:*
Can you work over time?:
Can you work weekends?:
Are you at least 18 years of age?:*
Are you able to work any shift?:*
If no, what shift can you work?:*
Do you have reliable means of transportation to and from work?:*
Can you travel if the job requires?:*

Employment is conditional on providing proof of eligibility within 3 days of employment

Do you have the legal right to work in the U.S.?:*
Are you able to perform the essential functions of the job for which you are applying? Including regular attendance with or without reasonable accommodation?:*
If no, describe the functions you are unable to perform?:
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Have you ever been convicted of, or pled nolo contendere to, any crime, which is substantially related to your ability to perform the job for which you applied?:*

Convictions will not necessarily disqualify an applicant from employment.

Do not provide information about (1) marijuana convictions more than 2 years old; (2) conviction about which the court record has been sealed or expunged or (3) any conviction more than 10 years old.

Nature of Crime:(1)
When:(1)
Where:(1)
Disposition of Case:(1)
Nature of Crime:(2)
When:(2)
Where:(2)
Disposition of Case:(2)
Nature of Crime1:(2)
When:(3)
Where:(3)
Disposition of Case:(3)

(Answer only if probability of driving a company vehicle exists for the position in which you are applying)

Do you have a valid driver’s license?:*
What classes of license do you posses?:*
Have you had a suspension or probation of your license within the last (5) years?:*
How many speeding or other moving violations have you had in the last three (3) years?:*

List all traffic violations (except parking) on your record for the last five (5) years and all accidents for which you are responsible:

Date: (1)
Location: (1)
Description: (1)
Result: (1)
Date: (2)
Location: (2)
Description: (2)
Result: (2)
Date: (3)
Location: (3)
Description: (3)
Result: (3)
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EDUCATION / TRAINING RECORD

School Attended

Last High School: (1)
Name of School: (1)
City and State: (1)
Last Grade Completed: (1)
Degree / Diploma: (1)
Major: (1)
Trade/Business School: (2)
Name of School: (2)
City and State: (2)
Last Grade Completed: (2)
Degree / Diploma: (2)
Major: (2)
College or University: (3)
Name of School: (3)
City and State: (3)
Last Grade Completed: (3)
Degree / Diploma: (3)
Major: (3)
Graduate School: (4)
Name of School: (4)
City and State: (4)
Last Grade Completed: (4)
Degree / Diploma: (4)
Major: (4)
Adult Education classes or special skills (e.g. Personal Computer):

Foreign Languages

Foreign Language: (1)
Choose the one that applies to you: (1)
Foreign Language: (2)
Choose the one that applies to you: (2)
Certification/License: (1)
Number: (1)
State: (1)
Expiration Date: (1)
Ever Revoked: (1)
Certification/License: (2)
Number: (2)
State: (2)
Expiration Date: (2)
Ever Revoked: (2)
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WORK EXPERIENCE

Please list the names of your present and previous employers in chronological order, with present or last employer listed first. Be sure to account for all periods of time (attach additional page if necessary, including military service and any period(s) of unemployment.

Present or Most Recent Employment

Name of Employer: (1)
Type of Business: (1)
Address: (1)
Phone #: (1)
-
From: (1)
To: (1)
Starting Pay: (1)
Final Pay: (1)
Job Title: (1)
May we contact?: (1)
Name of Supervisor: (1)
Supervisor’s Job Title: (1)
Reason for Leaving: (1)
Description of work and responsibilities: (1)

Previous Employment

Name of Employer: (2)
Type of Business: (2)
Address: (2)
Phone #: (2)
-
From: (2)
To: (2)
Starting Pay: (2)
Final Pay: (2)
Job Title: (2)
May we contact?: (2)
Name of Supervisor: (2)
Supervisor’s Job Title: (2)
Reason for Leaving: (2)
Description of work and responsibilities: (2)
Name of Employer: (3)
Type of Business: (3)
Address: (3)
Phone #: (3)
-
From: (3)
To: (3)
Starting Pay: (3)
Final Pay: (3)
Job Title: (3)
May we contact?: (3)
Name of Supervisor: (3)
Supervisor’s Job Title: (1)(1)(1)
Reason for Leaving: (3)
Description of work and responsibilities: (3)
Name of Employer: (4)
Type of Business: (4)
Address: (4)
Phone #: (4)
-
From: (4)
To: (4)
Starting Pay: (4)
Final Pay: (4)
Job Title: (4)
May we contact?: (4)
Name of Supervisor: (4)
Supervisor’s Job Title: (4)
Reason for Leaving: (4)
Description of work and responsibilities: (4)
Name of Employer: (5)
Type of Business: (5)
Address: (5)
Phone #: (5)
-
From: (5)
To: (5)
Starting Pay: (5)
Final Pay: (5)
Job Title: (5)
May we contact?: (5)
Name of Supervisor: (5)
Supervisor’s Job Title: (5)
Reason for Leaving: (5)
Description of work and responsibilities: (5)
Have you ever received any written reprimands or disciplinary suspensions during any previous employment?
If yes, please explain: (1)
Have you ever been discharged or asked to resign?:
If yes, please explain: (2)
Please explain fully any gaps in your employment history:
Upload your resume:*
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PERSONAL REFERENCES

List below three persons not related to you who have knowledge of your work performance within the last five years

Name: (1)
Years Acquainted: (1)
Phone Number: (1)
-
Address: (1.)
Name: (2)
Years Acquainted: (2)
Phone Number: (2)
-
Address: (2.)
Name: (3)
Years Acquainted: (3)
Phone Number: (3)
-
Address: (3.)

EMERGENCY CONTACT

Emergency Contact Name:
Relationship:.
Address:.
Telephone Number:
-

EMPLOYMENT APPLICATION CERTIFICATION

Please read carefully, initial each paragraph and sign below

Certification Statement:

I hereby state that all the information that I have provided on this application, and in any job interview, is true, complete and correct. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand if selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.

Initials: (1):
Certification Statement:

I understand that I may be required to submit to a test for the presence of controlled substances and/or illegal drugs in my system prior to employment and at any time during my employment, to the fullest extent permitted by law. I also understand that my ability to begin employment may be contingent upon my passing of a drug test and/or physical examination performed by a doctor selected by the Company. I consent to the disclosure of the results of any drug test and/or physical examination to Company.

Initials: (2)
Certification Statement:

I understand that the Company may investigate my criminal record and my employment history. I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby fully waive any rights or claims I have or may have against the Company my former employers, their agents, employees and representatives, as well as other individuals who disclose information to the Company and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me. I authorize the person named as references to provide the Company with any pertinent information they may have regarding me.

Initials: (3)*
Certification Statement:

I understand that if hired, the Company can change wages, benefits, and regulations, terms and conditions at any time and for any reason. I agree to comply with and be bound by rules and regulations of the Company as in effect from time to time.

Initials: (4)
Certification Statement:

If hired, I agree that my employment will be terminable at-will and for no definite period. I agree that my employment may be terminated by the Company or myself at any time and for any reason whatsoever, with or without good cause. No implied, oral or written agreements contrary to the express language of this agreement or purporting to amend or modify this agreement are valid unless they are in writing and signed by the President of the Company. I understand that no supervisor or representative of the Company, other than the President of the Company has any authority to make any agreements contrary to the foregoing and only in writing. This agreement and the Associate Handbook constitute the entire agreement between myself and the Company regarding the rights of the Company or myself to terminate my employment with or without good cause, and this agreement takes the place of all prior and contemporaneous agreements, representation, and understandings of myself and the Company.

Initials: (5)
Certification Statement:

I agree that any claim, dispute, or controversy (including, but not limited to, any and all claims of discrimination and harassment) which would otherwise require or allow resort to any court or other governmental dispute resolution forum between myself and the Company (or its owners, directors, officer, managers, employees, agents, and parties affiliated with its employee benefit and health plans) arising from, related to, or having any relationship or connection whatsoever with my seeking employment with, employment by, or other association with the Company, whether, based on tort, contract, statutory, or equitable law, or otherwise, (with the sole exception of claims arising under the National Labor Relations Act which are brought before the National Labor Relations Board, claims for medical and disability benefits under the California Workers Compensations Act, and Employment Development Department claims), shall be submitted to and determined exclusively by binding arbitration under the Federal Arbitration Act, in conformity with the procedures of the California Arbitration Act (Cal., Code Civ. Proc. Sec 1280 et seq., including Section 1283.05 and all of the Act’s other mandatory and permissive rights to discovery); provided, however, that: In addition to requirements imposed by law, any arbitrator herein shall be a retired California Superior Court judge and shall be subject to disqualification on the same grounds as would apply to a judge of such court. To the extent applicable in civil actions in California courts, the following shall apply and be observes: all rules of pleading (including the rights of demurrer), all rules of evidence, all rights to resolution of the dispute by means of motions for summary judgments, judgment on the pleadings, and judgment under Code of Civil Procedure Section 631.8. Resolution of the dispute shall be based solely upon the law governing the claims and defenses pleaded, and the arbitrator may not invoke any basis (including but not limited to notions of “just cause”) other than such controlling law. The arbitrator shall have the immunity of a judicial officer from civil liability when acting in the capacity of an arbitrator, which immunity supplements any other existing immunity. Likewise, all communications during or in connection with the arbitration proceedings are privileged in accordance with Cal. Civil Code Section 47 (b). As reasonably required to allow full use and benefit of this agreement’s modifications to the act’s procedures, the arbitrator shall extend the times set by the act for the giving of notices and setting of hearings. Awards shall include the arbitrator’s written reasoned opinion and, at either party’s written request within 10 days after issuance of the award, shall be subject to reversal and remand, modification, or reduction following review of the record and arguments of the parties by a second arbitrator who shall, as far as practicable, proceed according to the law and procedures applicable to appellate review by the California Court of Appeal of a Civil judgment following court trial.

I understand that by agreeing to this arbitration provision, both I and the company give up our rights to trial by jury, and I hereby knowingly and voluntarily waive my rights to a jury trial.

If you have any questions regarding this statement, please ask a Company representative before signing. I hereby acknowledge that I have read the above statements and understand the same.

Initials: (6)
Certification Statement:

If my application is accepted for employment, I understand that it is my responsibility to keep accurate and complete record of my hours worked each day

Initials: (7)

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENTS AND AGREEMENT

Applicant’s Signature*
Date:*
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