APPLICATION FOR EMPLOYMENT
PRINT CLEARLY. COMPLETE ALL ITEMS USING A BALL-POINT PEN.
Legal Name: Last: _______________________ First: _______________________ MI: _______
Interviewed
By: ___________________
Date of Application: _________________________ Date Available: _______________________
(NOTE TO INTERVIEWER. This
Application should be free of any
notes, comments, or markings,
concerning the applicant.)
Address: Street: __________________________________ Apt./Suite No.: _________________
City:__________________________State: ______________ Zip Code: ____________________
Home Phone No. ( _____ ) ________________ Work Phone No.: ( _____ ) ________________
Age (Circle One) Under 16
16
17
18
19
20
If you are under 18, do you have a work permit? _____ Yes _____ No
21 or older
Do you have the legal right to work in the United States? _____ Yes _____ NO
(To be hired, proper I-9 Employment Eligibility Verification will be required.)
Drivers License #:
State License was issued:
Education:
No. Years Completed
Name and Location of School
Degree of Diploma
High
Tech
College
Position Applied For ____________________________________________
I am available to work:
Have you ever worked for Centerplate or its affiliated companies? If yes, please
circle the company or companies for which you have worked.
Service America Corporation
Volume Services, Inc.
Volume Services America
Centerplate
BCG
Boston Culinary Group
John Harvard
Full Time
Part Time
Weekends
Temporary
Shift
When? __________ to __________ Last Location: ______________________
Last Position: ________________________
Have you ever been convicted of a felony?
_____ Yes
_____ No
If yes, when? ___________________________________
(A conviction will not necessarily disqualify you from employment.) To help us evaluate your application, please describe the nature
of the felony and your subsequent rehabilitation.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
EMPLOYMENT HISTORY
Date
Employer:
From
Describe job duties briefly:
To
Address:
Phone:
Mo./Yr.
Job Title:
Hrly. Rate/Salary
Starting
Final
Mo./Yr.
Supervisor:
Title:
Employer:
Address:
Phone:
Job Title:
Date
From
To
Mo./Yr.
Mo./Yr.
Hrly. Rate/Salary
Job Title:
Supervisor:
Title:
__ No
Describe job duties briefly:
Reason for leaving:
Final
Supervisor:
Title:
Address:
Phone:
Reason for leaving:
May we contact employer? __ Yes
Starting
Employer:
(List your current or most recent employer first.)
May we contact employer? __ Yes
Date
From
To
Mo./Yr.
Mo./Yr.
Hrly. Rate/Salary
Starting
Final
__ No
Describe job duties briefly:
Reason for leaving:
May we contact employer? __ Yes
Explain any gaps in employment of 3 months or more:
__ No
AGREEMENT
I certify that all of my answers in this Employment Application are true and complete and may be relied upon by Centerplate. I understand that this Application will remain active for ninety (90) days. At the conclusion of that time, if I have not heard from the
Employer, and I still wish to be considered for employment, then it will be necessary to fill out a new Application.
I understand that any false or misleading answer (s) or willful omissions of pertinent information in this Employment Application or
any other pre-employment inquiry will be grounds for rejection of my application, or immediate termination if I have become employed.
I authorize the Company to investigate and verify my answers and I give the Company permission to contact previous employers,
schools, references, and others in its investigation. I release both the Company and the party providing the information from any
liability for this purpose.
The Company provides its employees a DRUG FREE WORKPLACE, and I understand that the Company may require drug and
alcohol testing as a condition of employment, or as a condition of continued employment, subject to application of federal and state
laws, and I consent to any such testing.
If employed, I will comply with all Company policies and rules found in any employee handbook, Company policy manual, or other
communications from the Company.
I understand that the terms and conditions of my employment can be changed with or without cause, at any time by the Company,
and that my employment may be ended at any time, for any reason, by the Company or by me.
I agree not to use or disclose outside my employment with the Company, any confidential information, trade secrets, or proprietary
information, whatsoever its form, obtained in connection with my employment with the Company.
In connection with your application for employment with Centerplate, your social security number will be verified. Centerplate also
may obtain a background report about you, which may include, but is not limited to, information regarding your credit standing,
driving record, history of criminal convictions, personal characteristics and general reputation.
I voluntarily and knowingly authorize, for employment purposes only, Centerplate and its subsidiaries
(collectively "Centerplate") to verify my social security number. I also voluntarily and knowingly authorize, for
employment purposes only, Centerplate to have Pinkerton Consulting and Investigations, located at 11019
McCormick Road, Suite 120, Hunt Valley, Maryland 21031 (800-635-1649) or another Consumer Reporting
Agency, obtain a background report which may include, but is not limited to, information regarding my credit
standing, driving record, history of criminal convictions, personal characteristics and general reputation.
Please provide the address for each residence over the past seven years. Use additional paper if necessary.
_______________________________________________________________________________________________________
Address
City
State
Zip code
County
___________________________________________________________________________________________________________________
Address
City
State
Zip code
County
___________________________________________________________________________________________________________________
Address
City
State
Zip code
County
_______________________________________________________________________________________________________
Address
City
State
Zip code
County
_______________________________________________________________________________________________________
Address
City
State
Zip code
County
I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS:
Applicant’s Signature:
Date:
For Internal Use Only:
If applicant is applying for a position in the cash room, for security or for a high level management position, send a copy of
this application and a completely filed out Pinkerton disclosure form to Corporate Human Resources at 201 East Broad
Street, Spartanburg, SC 29306 via a trackable overnight service. Be sure to include the unit name, email address and phone
number of person requesting information.
_________________________________________
Unit Name
__________________________________________
Email Address
_________________________
Phone Number
CENTERPLATE IS AN EQUAL OPPORTUNITY EMPLOYER THAT DOES NOT DISCRIMINATE BECAUSE OF SEX, AGE, RACE, COLOR,
RELIGIOUS CREED, MARITAL OR VETERAN STATUS, CITIZENSHIP, NATIONAL ORIGIN ANCESTRY, SEXUAL ORIENTATION,
HANDICAP OR DISABILITY, GENETIC INFORMATION, OBLIGATION TO SERVE IN THE ARMED FORCES OF THE U.S. OR ANY
OTHER CHARACTERISTIC PROTECTED BY APPLICABLE FEDERAL, STATE OR LOCAL LAWS.
YOU MUST SIGN THE ATTACHED PINKERTON DISCLOSURE FORM AND
RECEIVE THE FAIR CREDIT REPORTING ACT NOTICE OF RIGHTS.
DISCLOSURE AND AUTHORIZATION
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING
AUTHORIZATION]
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Centerplate (“the Company”) may obtain information about you for employment purposes from a third party consumer reporting agency. Thus,
you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character,
general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your
neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security
verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit
history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are
applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about
you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that
the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an
investigation into your education and/or employment history conducted by Pinkerton Consulting and Investigations, 11019 McCormick Road,
Suite 120, Hunt Valley, MD, 800-635-1649, or another outside organization. The scope of this notice and authorization is all-encompassing,
however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports
now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to
exercise your right to request disclosure of the nature and scope of any investigative consumer report.
New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report
requested by Centerplate by contacting the consumer reporting agency identified above directly. You may also contact the Company to
request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries,
which the Company shall provide within 5 days.
New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by
Centerplate, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report.
By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft
protection, the storage and disposal of your credit information, and remedies available should you suspect or find that the Company has not
maintained secured records is available to you upon request.
Washington State applicants or employees only: You also have the right to request from the consumer reporting agency a written summary
of your rights and remedies under the Washington Fair Credit Reporting Act.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER
THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining
of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my
employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal
agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all
background information requested by Pinkerton Consulting and Investigations, 11019 McCormick Road, Suite 120, Hunt Valley, MD, 800-6351649, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile (“fax”), electronic or
photographic copy of this Authorization shall be as valid as the original.
New York applicants or employees only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one
is obtained by the Company. □
California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND
INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer
report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under
California law. □
Social Security* #
Date of Birth*
Signature:
Date:
NOTICE OF AND CONSENT TO A CONSUMER REPORT BEING OBTAINED
PURSUANT TO THE FAIR CREDIT REPORTING ACT
In processing my application for employment, I understand that Centerplate may obtain or have
prepared a consumer report or investigative consumer report for employment purposes, concerning
my prior employment, military record, education, credit worthiness, credit standing, credit capacity,
character, general reputation, personal characteristics, criminal background, or mode of living.
I understand that an investigative consumer report is a report in which information concerning my
character, general reputation, personal characteristics, or mode of living is obtained through personal
interviews with former employers, neighbors, friends or associates with whom I am acquainted.
By signing below, I am authorizing Centerplate or its agent to obtain a consumer or investigative
consumer report on me as part of the Company’s pre-employment background screening process. If I
am offered employment by the Company, I further authorize the Company to obtain additional
consumer or investigative consumer reports on me for employment purposes at any time during my
employment. I release Centerplate and any person or entity that provides information as a part of the
background report or consumer investigative report from any liability related to the report(s) or
information given.
By my signature below, I also acknowledge that the Company has provided me with a copy of the
“Summary of Your Rights under the Fair Credit Reporting Act.”
Signature of Applicant:______________________________ Date:___________________
Print Name:____________________________________
Witness:_______________________________________ Date:___________________
Print Name:____________________________________