APPLICATION FOR EMPLOYMENT

Application Date____________

NAME __________________________________  BIRTHDAY ________________________________________

IF KNOWN BY ANOTHER NAME, PLEASE STATE _______________________________________________________

HOME ADDRESS ____________________________________ZIP ____________ TELEPHONE___________________

AGE, IF UNDER 18 ____ HOW LONG HAVE YOU LIVED AT PRESENT ADDRESS ___    ________________________

DO YOU HAVE THE RIGHT TO WORK AND REMAIN IN THE UNITED STATES OF AMERICA?               YES           NO

PROOF OF IDENTITY AND LEGAL AUTHORITY TO WORK IN THE U.S. IS A CONDITION OF EMPLOYMENT

JOB (S) DESIRED ________________________________________ WILL YOU WORK ANY SHIFT         YES           NO

IF YES, WHAT SHIFT PREFERRED? __________________________________________________________________

IF NO, WHAT SHIFT WILL YOU WORK? _______________________________________________________________

WILL YOU WORK OVERTIME, IF REQUIRED?        Please circle one                YES                 NO

WILL WORK WEEKENDS AND HOLIDAYS?        Please circle one                YES                 NO

HAVE YOU EVER WORKED AT A BAR OR RESTAURANT?        YES       NO

IF YES, WHAT LOCATION ______________________________ POSITION ___________________________________

DATES: FROM ________ TO ________ REASON FOR LEAVING ___________________________________________

HAVE YOU BEEN CONVICTED OF A FELONY?                   YES        NO

IF YES, GIVE DETAILS _____________________________________________________________________________

(A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FROM EMPLOYMENT. EACH CASE WILL BE EVALUATED ON ITS OWN MERIT)

IN CASE OF EMERGENCY NOTIFY:

NAME _________________________________ TELEPHONE # _____________________________________________

THE HOPPER PUB AND PIZZERIA IS AN EQUAL OPPORTUNITY EMPLOYER. IT IS THE POLICY OF THIS FRANCHISEE TO SEEK AND EMPLOY THE BEST QUALIFIED PERSONNEL, TO PROVIDE EQUAL OPPORTUNITIES FOR THE ADVANCEMENT OF EMPLOYEES INCLUDING UPGRADING AND TRAINING AND TO CONDUCT THESE ACTIVITIES IN A MANNER WHICH WILL NOT DISCRIMINATE AGAINST ANY PERSON BECAUSE OF ANY PROTECTED CHARACTERISTIC, SUCH AS RACE, RELIGION, NATIONAL ORIGIN, COLOR, SEX, AGE, DISABILITY OR ANY OTHER CONSIDERATION MADE UNLAWFUL BY FEDERAL, STATE OR LOCAL LAWS.

(OVER)

EDUCATION RECORD

WORK EXPERIENCE

(PLEASE START WITH PRESENT OR MOST RECENT POSITION)

I understand that I am applying for employment with The Hopper Pub & Pizzeria.

I certify that the information furnished above is complete and correct to the best of my knowledge, and I understand that any misrepresentation or omission of material fact will constitute grounds for immediate dismissal. I authorize the companies, schools. And persons named above, and others, to furnish the above named employer with any information they may have regarding me. I agree that such companies, schools, persons, and others, shall not be liable in any respect if my employment is terminated because of the misrepresentation or omission of material facts in this questionnaire.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the above named employer and me for either employment or for the providing of any benefit, and that my employer’s personnel policies and/or handbooks do not constitute an employment contract. I may be discharged at any time, with or without cause, and with or without notice, at any time, either at my option or at the option of my employer.

DATE _____________________________________    SIGNED _______________________________________________________