3001 S. Washburn St.
Suite B01
Oshkosh, WI 54904
Phone: 920.231.4561
Fax: 920.231.8915
Hiring Cooks & Servers for
the new Johnny Rockets
Restaurant in Oshkosh
To apply, complete the following application forms and deliver via:
email:
[email protected]
fax:
920-231-8915
in person:
The Outlet Shoppes at Oshkosh Guest Services office (between Gap & Old Navy)
Horizon JR Oshkosh
Employment Application
________________________
An Equal Opportunity Employer
It is the policy of the Company to afford equal employment opportunity regardless of a
person’s race, religion, color, national origin, sex, marital status, height, weight, or disability.
A PERSON WITH A DISABILITY REQUIRING ACCOMODATION TO COMPLETE THE
APPLICATION PROCESS SHOULD NOTIFY ________________ AS SOON AS POSSIBLE.
NAME (Last, First, Middle Initial)
TODAY’S DATE
SOCIAL SECURITY NUMBER
(
)
TELEPHONE NUMBER
ADDRESS
City
State
Zip
The careful and thoughtful completion of this application is an important step in our consideration of individuals for employment. Please
complete the entire application. Ask for an extra piece of paper if you need to clarify any responses. Your application will become
inactive after 30 calendar days unless you inform us, in writing, and prior to the expiration of the 30-day period, that you want your
application to remain active. Before you sign this application, please ask the personnel person any questions that you may have.
Thank you.
ARE YOU AT LEAST 18 YEARS OLD? _______ HAVE YOU WORKED FOR THE COMPANY UNDER A DIFFERENT
NAME BEFORE? ______________________________________ ANY ADDITIONAL INFORMATION RELATIVE TO A
DIFFERENT NAME NECESSARY TO CHECK YOUR WORK RECORD? _____________________________________
POSITION FOR WHICH YOU ARE APPLYING
POSITION (USE SPECIFIC TITLE) __________________________________________DATE AVAILABLE ______________
ARE YOU PRESENTLY EMPLOYED? ______ IF YES, WHERE? _______________________________________________
ARE YOU SUBJECT TO RECALL AT ANOTHER JOB? _______ IF YES, EXPLAIN ________________________________
____________________________________________________________________________________________________
HAVE YOU EVER APPLIED TO THIS FACILITY BEFORE? _____ IF SO, FOR WHAT POSITION? ____________________
WHEN? ________ WAGE EXPECTED? ________ ARE YOU RELATED TO OR KNOW ANYONE WHO CURRENTLY
WORKS FOR THE COMPANY? ______ IF YES, PLEASE NAME THE INDIVIDUAL(S) ______________________________
CAN YOU PERFORM THE ESSENTIAL DUTIES OF THE JOB WITH OR WITHOUT ACCOMODATION? ________________
EDUCATION
Names and
Location
Course of
Study
Years
Completed
Graduate?
(Yes / No)
Diploma
or Degree?
GPA
HIGH
SCHOOL __________________________________________________________________________________________________
__________________________________________________________________________________________________
COLLEGE __________________________________________________________________________________________________
__________________________________________________________________________________________________
OTHER
__________________________________________________________________________________________________
OTHER FORMAL EDUCATION OR EXPERIENCE WHICH YOU FEEL IS RELEVANT TO THE POSITION FOR WHICH YOU ARE
APPLYING __________________________________________________________________________________________________
___________________________________________________________________________________________________________
HAVE YOU EVER BEEN CONVICTED OF A CRIME? _____ IF YES, STATE THE CRIME(S), AND THE DATE AND
LOCATION OF THE CONVICTION ____________________________________________________________________
ARE ANY FELONY CHARGES CURRENTLY PENDING AGAINST YOU? _____ IF YES, EXPLAIN ________________
WHAT OTHER EMPLOYMENT OR “SIDELINE” BUSINESS DO YOU HAVE? __________________________________
WOULD YOU WANT TO CONTINUE IT IF EMPLOYED BY US? _____________________________________________
PERSONAL REFERENCES
1.
__________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
EMPLOYMENT HISTORY
(List below past and present employment, starting with most recent. Include employment with U.S. military service. Do not skip any employers)
1. NAME & ADDRESS: ______________________________________________________________________________
STARTING
ENDING
POSITION ___________________________ SALARY ___________________
SALARY __________________
DESCRIPTION OF DUTIES ________________________________________________________________________
SUPERVISOR’S NAME ____________________________ DATES EMPLOYED FROM _________ TO __________
REASON(S) FOR LEAVING ________________________________________________________________________
2. NAME & ADDRESS: _____________________________________________________________________________
STARTING
ENDING
POSITION ___________________________ SALARY ___________________
SALARY __________________
DESCRIPTION OF DUTIES ________________________________________________________________________
SUPERVISOR’S NAME ____________________________ DATES EMPLOYED FROM _________ TO __________
REASON(S) FOR LEAVING ________________________________________________________________________
3. NAME & ADDRESS: ______________________________________________________________________________
STARTING
ENDING
POSITION ___________________________ SALARY ___________________
SALARY __________________
DESCRIPTION OF DUTIES ________________________________________________________________________
SUPERVISOR’S NAME ____________________________ DATES EMPLOYED FROM _________ TO __________
REASON(S) FOR LEAVING ________________________________________________________________________
APPLICANT STATEMENT
I hereby affirm the information provided on this application (and accompanying resume, if any) is true and complete. I also agree that any false
information, misrepresentations, or omissions may disqualify me from further consideration for employment and may result in discipline or dismissal if
discovered at a later date.
I authorize this company to investigate all statements contained in this application, including disciplinary records of any former employers, police
departments, and other references or sources concerning me. I authorize all such references and sources (and the company) release this information
without liability for damage incurred in giving it. I waive any written notice of the release of such records that may be required by state or federal law.
I understand that all employees of ________________________________ are employed on an indefinite basis and are subject to termination at any
time, with or without prior notice, discipline or warning, for any or no reason.
___________________________________________
DATE
________________________________________________________________
APPLICANT SIGNATURE
Horizon JR Oshkosh
Work Availability
Please line through the hours you are availble to work
SUN
MON
TUES
WED
THUR
FRI
SAT
8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
For example the chart below indicates you can work from 10:00 to 4:00 on Sundays
SUN
8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
Candidates Name
Candidates Signature