APPLICATION FOR AT-WILL EMPLOYMENT
AN EQUAL OPPORTUNITY EMPLOYER PLEASE READ BEFORE COMPLETING THIS APPLICATION.
In reading and answering the following questions, please keep in mind that none of the questions is intended
to imply any limitations or discrimination based on non-job related information. By completing this application,
there is no assurance of employment. However, if a suitable opening occurs, this application may receive
due consideration. Use of this form does not indicate that there are positions available.
Date:
Last Name
First Name
Present Street Address
Middle Initial
City/State
Zip Code
Social Security number
Phone number
(
Emergency Contact
Phone number
Are you a citizen of the U.S. or do
you have a legal right to work in
the U.S.?
Position desired:


(
)


Yes
No
E-mail address
)
Any offer of employment is conditioned upon completing an I-9 Form and
providing documents establishing identity and work authorization. Yogurt Lab
uses the government’s e-verification system to verify I-9 information.
Full-Time
Part-Time


Yes
No
Do you have any friends, relatives, or
acquaintances working for Yogurt Lab?


Yes
No
Are you 18
years of age
or older?
Alternate Phone number
(
Have you previously applied for employment
with Yogurt Lab?
Date available for employment:
)


Yes
No
 Morning/Day
 Day/Evening
If Yes, when?
Salary desired:
If Yes, Name & Relationship
If under 18 years of age, applicant will be required to submit proof of
age or work certificate as required by State or Federal law.
Do you have any other commitments
If yes, please explain:
 Yes
with another employer that may relate
 No
to the position you are applying for?
Can you perform, with or without reasonable accommodation, the essential functions of this job?
If you have any questions about the functions of this job, please ask the interviewer before answering this
question.
Graduated?
Yes
No
Name and city of last school attended:
Degree
Type


Yes
No
Major
GPA
If yes, please explain:
 Yes
Do you have any food
related education?
 No
If yes, please explain:
Do you have any food
 Yes
related experience?
 No
List any other education, accomplishments or special interests that would benefit you in this position:
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
From
To
Total hours per week available for work:
How far do you live from the restaurant location?
Professional References – Do not list friends or family members
Name/Occupation
1.
2.
3.
Phone Numbers
How Known?
Employment History
(List all present and past employment beginning with the most recent. Use additional pages as necessary.)
Company Name and Address:
Immediate supervisor:
Phone:
( )
Reason for leaving: (If applicable)
Pay rate at beginning and end of employment:
Dates of employment:
Beginning:
From:
Ending:
To:



Job Title:
May we contact
this employer?
Company Name and Address:
Phone:
( )
Reason for leaving: (If applicable)
Immediate supervisor:
Pay rate at time of employment:
Dates of employment:
Beginning:
From:
Ending:
To:



Job Title:
May we contact
this employer?
Company Name and Address:
Phone:
( )
Reason for leaving: (If applicable)
Yes
No
Yes, at a
later date
Yes
No
Yes, at a
later date
Immediate supervisor:
Pay rate at time of employment:
Dates of employment:
Beginning:
From:
Ending:
Job Title:
May we contact
this employer?
To:



Yes
No
Yes, at a
later date
Which of your previous jobs did you like best and why?
What will your previous supervisor tell us about you?
What does “customer service” mean to you?
Name 3 ways you could contribute to providing a great customer experience to Yogurt Lab guests:
Declaration
(Carefully read and initial each section then sign at bottom)
I certify that the answers given herein are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in
this application, with the exception of contacting my present employer if I have so requested. I have read, understand and agree to the above
statement.
(Please initial here)_______________
While this application will be retained on file for a period of one year, I acknowledge that this application will be considered active for a period of
sixty (60) days. At that time, I must submit a new application to be considered for any employment openings. I have read, understand and agree to
the above statement.
(Please initial here)_______________
I understand and acknowledge that unless otherwise defined by applicable law or written agreement with Yogurt Lab any employment relationship
with the Company is considered “employment at will,” which means the Employee may resign at any time and the Employer may discharge the
Employee at any time, with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written
document or by any conduct unless such change is specifically executed by the Company President/CEO. I have read, understand and agree to the
above statement.
(Please initial here)_______________
If I should be employed by the Company, I understand that any false, incomplete, or misleading information given on this application or during an
interview may result in immediate discharge. I have read, understand and agree to the above statement.
(Please initial here)_______________
I authorize an inquiry into my background by all persons, schools, companies, corporations, credit bureaus, law enforcement agencies, and other
consumer reporting agencies to supply information concerning my previous employment, education, credit, driving record, etc. I have read,
understand and agree to the above statement.
(Please initial here)_______________
I authorize the references listed above to give representatives of the Company any and all information concerning my previous or current
employment and any pertinent information they may have, personal or otherwise, and release all parties from any and all liability from any damage
that may result. I have read, understand and agree to the above statement.
(Please initial here)_______________
Signature:
Date