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KC DAIQUIRI SHOP EMPLOYMENT APPLICATION

An Equal Opportunity Employer – All qualified applications will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by law.

Your Personal Information

Your Name*

Email*

Phone*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Additional Information

Are you eligible to work in the United States of America?*

Yes

No

Have you ever been convicted of a felony?*

Yes

No

Are you at least 21 years old?*

Yes

No

Have you ever been terminated from employment or asked to resign?*

Yes

No

If YES, please provide details.

Employment Desired

What position are you applying for?*

Can you perform the essential functions of the job you are applying for?*

Yes

No

When can you start?*

Availability*

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Are you presently Employed?*

Yes

No

if YES, may we contact your employer?

Yes

No

If presently employed, why are you considering leaving

Education

School

Name

Years attended

Studies/Major

Degree/diploma

Have you completed any special courses, seminars and/or training directly related to the position for which you are applying?

Yes

No

If YES, please describe.

Work Experience

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you for further consideration.

Employer Name*

Supervisor*

Phone Number*

Address*

Start Date*

End Date*

Job Title*

Reason for Leaving*

Summarize the nature of work performed and job responsibilities.*

May we contact your employer?*

Yes

No

Employer Name

Supervisor

Phone Number

Address

Start Date

End Date

Job Title

Reason for Leaving

Summarize the nature of work performed and job responsibilities.

May we contact your employer?

Yes

No

Employer Name

Supervisor

Phone Number

Address

Start Date

End Date

Job Title

Reason for Leaving

Summarize the nature of work performed and job responsibilities.

May we contact your employer?

Yes

No

References

Please give the name of three (3) persons not related to you, whom you have known at least three (3) years. Exclude relatives and former employers.

Name

Phone

Company

Years Acquainted

More About You

Signature*

Please read carefully before signing. Pursuant to the federal Fair Credit Reporting Act, I hereby authorize the KC Daiquiri Shop and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records. I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish the KC Daiquiri Shop or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the KC Daiquiri Shop to hire me. If I am hired, I understand that either the KC Daiquiri Shop or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the KC Daiquiri Shop has the authority to make any assurance to the contrary. I attest with my signature below that I have given to the KC Daiquiri Shop true and complete information on this application. No requested information has been concealed. If information I have provided is untrue, or if I have concealed material information, can result in disqualification for employment consideration, or if hired, may be grounds for termination.