Hire Date
Personal Information
Last Name
Date Applying
Middle
First
Present Address (within last 5 years)
City
State
Zip Code
City/State
Zip Code
Home Phone #
Business Phone #
Do you have transportation?
Yes
No
Cellular #/other
Social Security #
Date of Birth
Previous Address
Are you 18 years or older?
Yes
No
Are you legally authorized or permitted to work in the United
Have you been arrested or convicted of a crime?
States?
Yes
No
(Answering yes to this question does not deny
What is your status? __________________________________
consideration for the position).
Yes
No
____________________________________________________ Yes__________________________________________
________________________Date_________________
Do you have any medical condition that requires assistance or medication in case of any emergency?
___________________________________________________________________________________________________
Desired Employment
Position
Interested in:
Full Time
Check the days and hours available to work
Sunday
Monday
AM
PM
Date you can start
Tuesday
Salary desired
Wednesday
Part Time
Thursday
Seasonal/Temp
Friday
Saturday
Who referred you?
Education
School Level
Grammar School
High School
College
Trade Schools
Name & Location of School
Did you graduate?
Subjects Studied
References
List personal references only if you have NO occupational references.
Name
Relation
Occupation
Phone #
Years
acquainted
1.
2.
3.
Employment History
List below the last three employers, starting with the most recent.
Present or last employer
Address
Starting date
Starting salary
Leaving date
Ending salary
Name of Supervisor
Title
City/ State
Job title
May we contact your supervisor?
Yes
No
Phone #
Description of work
Reason for leaving
Previous employer
Address
Starting date
Starting salary
Leaving date
Ending salary
Name of Supervisor
Title
City/ State
Job title
May we contact your supervisor?
Yes
No
Phone #
Description of work
Reason for leaving
Previous employer
Address
Starting date
Starting salary
Leaving date
Ending salary
Name of Supervisor
Title
Description of work
Reason for leaving
City/ State
Job title
May we contact your supervisor?
Yes
No
Phone #
About us (Please fill out this section during interview)
Briefly describe, Why would you like to work at Giardino gourmet salads? and,
What do you think about this healthy fast food concept?
Authorization
I understand that the filing of an application is a preliminary step to employment. It does not obligate
Giardino gourmet salads to offer employment, or the applicant to accept employment.
I certify that the facts contained in this application are true and complete to the best of my knowledge and
understand that, if employed; falsified statements on this application shall be grounds for dismissal.
I authorize investigations of all statement contained herein and the references and employers listed above to
give you any and all information concerning my previous employment and any pertinent information they may
have, personal or otherwise and release the company from all liability for any damage that may result from
utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreement contrary to the
foregoing, unless it is in writing and signed by an authorized company representative.
I understand that if I receive an offer of employment and I accept the position, I will be required to complete
additional information necessary for company record keeping requirements.
Signature ______________________________________ Date______________________________________
INTERVIEWER’S USE ONLY
Interviewed by
Comments
Date