"Employment Application Form - Dairy Queen"

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Lebanon Valley Mall DQ
Dairy Queen West
2600 West Cumberland St.
(717) 272- 8786
(717) 272- 8786
RETURN APPLICATION
Dairy Queen of Palmyra
SEALED IN THE
5 North Londonderry Square
PROVIDED ENVELOPE
(717) 838-5900
EMPLOYMENT APPLICATION
We are an equal opportunity employer. No question is asked for the purpose of excluding any applicant due to race, creed, color, national
origin, age, sex, veteran status, disability, or any other class of individuals protected by law.
PERSONAL
Social Security Number
Last Name
First Name
Middle Name
Current Mailing Address
Street
City
State
Zip
Permanent Address (if different from above) Street
City
State
Zip
Phone Number
Cell Phone Number (if applicable)
Date of Birth:
Are you Legally authorized to work in the United States?
Yes
No
POSITION APPLYING FOR
Hrs.Available
M
T
W
Th
F
S
Su
Are You Interested In:
Full
Part
Temporary
Seasonal
From
Have you ever worked in a fast food franchise before?
To
Yes
No
Date Available:
Salary Acceptable
TOTAL HOURS
If yes, for whom? _________________________________
Per Hour:
Available Per Week
From ____/_____/________ to ____/____/_________
Who Referred You To This Job?
Phone Number
Have you ever been convicted for a crime other than a major traffic violation?
(This information will be considered in hiring or job placement but
Yes
No If Yes, Explain:
will not automatically disqualify you for employment)
EDUCATION
Highest Grade Completed
Post Secondary
Other (Specify)
Grade Point Average
7 8
9
10
11
12
1
2
3
4
ACTIVITIES
Class Organizations, Scholastic Honors, and other school activities
(At your option, you may exclude organizations which indicate race, age,
sex, creed, color, national origin, religion, or other protected class.)
Hobbies and Recreational Interests
EMPLOYMENT RECORD
Name & Address of Present Employer
Employment Dates
From ____/_____/________ to ____/____/_________
Supervisor’s Name
Title
Phone
Position
Starting Salary
Final Salary
Reason for Leaving
May we contact this employer?
Yes, Immediately
Yes, at a Later Date
No, do not contact
Name & Address of Most Recent Employer
Employment Dates
(if other than present, if applicable)
From ____/_____/________ to ____/____/_________
Supervisor’s Name
Title
Phone
Position
Starting Salary
Final Salary
Reason for Leaving
May we contact this employer?
Yes, Immediately
Yes, at a Later Date
No, do not contact
INTERVIEW DATE AND TIME: ___/____/____
____:____ DATE HIRED: ____/____/____
OFFICE USE ONLY:
Lebanon Valley Mall DQ
Dairy Queen West
2600 West Cumberland St.
(717) 272- 8786
(717) 272- 8786
RETURN APPLICATION
Dairy Queen of Palmyra
SEALED IN THE
5 North Londonderry Square
PROVIDED ENVELOPE
(717) 838-5900
EMPLOYMENT APPLICATION
We are an equal opportunity employer. No question is asked for the purpose of excluding any applicant due to race, creed, color, national
origin, age, sex, veteran status, disability, or any other class of individuals protected by law.
PERSONAL
Social Security Number
Last Name
First Name
Middle Name
Current Mailing Address
Street
City
State
Zip
Permanent Address (if different from above) Street
City
State
Zip
Phone Number
Cell Phone Number (if applicable)
Date of Birth:
Are you Legally authorized to work in the United States?
Yes
No
POSITION APPLYING FOR
Hrs.Available
M
T
W
Th
F
S
Su
Are You Interested In:
Full
Part
Temporary
Seasonal
From
Have you ever worked in a fast food franchise before?
To
Yes
No
Date Available:
Salary Acceptable
TOTAL HOURS
If yes, for whom? _________________________________
Per Hour:
Available Per Week
From ____/_____/________ to ____/____/_________
Who Referred You To This Job?
Phone Number
Have you ever been convicted for a crime other than a major traffic violation?
(This information will be considered in hiring or job placement but
Yes
No If Yes, Explain:
will not automatically disqualify you for employment)
EDUCATION
Highest Grade Completed
Post Secondary
Other (Specify)
Grade Point Average
7 8
9
10
11
12
1
2
3
4
ACTIVITIES
Class Organizations, Scholastic Honors, and other school activities
(At your option, you may exclude organizations which indicate race, age,
sex, creed, color, national origin, religion, or other protected class.)
Hobbies and Recreational Interests
EMPLOYMENT RECORD
Name & Address of Present Employer
Employment Dates
From ____/_____/________ to ____/____/_________
Supervisor’s Name
Title
Phone
Position
Starting Salary
Final Salary
Reason for Leaving
May we contact this employer?
Yes, Immediately
Yes, at a Later Date
No, do not contact
Name & Address of Most Recent Employer
Employment Dates
(if other than present, if applicable)
From ____/_____/________ to ____/____/_________
Supervisor’s Name
Title
Phone
Position
Starting Salary
Final Salary
Reason for Leaving
May we contact this employer?
Yes, Immediately
Yes, at a Later Date
No, do not contact
INTERVIEW DATE AND TIME: ___/____/____
____:____ DATE HIRED: ____/____/____
OFFICE USE ONLY:
By Signing below, I authorize the store owner to investigate all statements made by me on this application
form. I understand that misstatements or omissions of information in connection with my application fore
employment can lead to rejection of my applications or dismissal from employment, whenever discovered. I
also authorize the store owner to request and receive references from my former employers and I hereby
release those employers supplying any information from liability.
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 store owner and myself for either employment or the providing
of any benefits. No promises regarding employment have been made to me and I understand that no such
promise or guarantee is binding upon the store owner unless expressly made in a formal written contract of
employment signed by me and an authorized representative of the store owner. If I am hired, I understand that
my employment would be “at will,” which means that I would have the right to terminate my employment at any
time for any reason and that the store owner would have the same right.
I hereby attest that all statements made by me above are true to the best of my knowledge.
Date __________________
Applicant’s Signature _________________________________________
Date __________________
Manager’s Signature _________________________________________
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