please tell us about yourself
Last Name First Name MI Preferred Name Current Address City State ZIP Years There Most Recent Previous Address City State ZIP Years There Social Security Number Are you 16 or older? Home Telephone Cell Phone Email Address what would you like to do at this franchise store?
Desired Salary/Wage How did you find out about A&W? Availability* Monday From Tuesday From Wednesday From Thursday From Friday From Saturday From Sunday From *If your religious beliefs or practices prohibit you from working on a particular day or at a particular time, The Franchisee will make reasonable efforts to accommodate those beliefs or practices in accordance with applicable law.
what schools have you attended?
High School Name, City, State Diploma or Degree Received
College
Name, City, State From
To Diploma or Degree Received
Other
Name, City, State From To Diploma or Degree Received two most recent jobs
Company and Address Telephone Supervisor Dates Worked What did you do? Last Salary/Wage Why did you leave? Company and Address Telephone Supervisor Dates Worked What did you do? Last Salary/Wage Why did you leave? miscellaneous information
Do you have reliable transportation to get to work?
If hired, when could you begin work? If hired, can you show proof of your legal right to work in the United States?
If you have worked for or have applied for employment with any of the
Company Stores, Franchisees, or Licensees listed below, please check the
appropriate boxes and then provide the information below.
Company and Address
Telephone Supervisor Dates Worked What did you do? Last Salary/Wage Why did you leave? references (please do not include family members as references.)
Name
Relationship to You
How long have you known this person? Type of Reference (School, Work, or Personal) Telephone Name Relationship to You How long have you known this person? Type of Reference (School, Work, or Personal) Telephone other information about yourself
1. Have you ever been convicted of, or pled guilty, no contest or nolo contendere to a crime involving, in any way, violence, sex, indecency, stalking, minors, theft, property damage, weapons,
dishonesty, fraud, robbery, burglary, or drugs?*
If you answered yes, please answer the following: Date of Conviction (or plea of guilty, no contest, or nolo contedre) Date sentence or parole completed * Crimes include felonies and misdemeanors only, not infractions or summary offenses. You should not respond "Yes" as a result of any conviction that has been judicially sealed, annulled, expunged, erased, statutorily
eradicated, dismissed by a First Offender's statute, or pardoned by the Governor. Conviction of a crime will not necessarily disqualify you from consideration for employment and will be considered only as it relates to the job
in question. CALIFORNIA residents do not respond "Yes" for (i) misdemeanor convictions for which you have successfully completed or otherwise discharged probation; (ii) misdemeanor marijuana convictions if the conviction
occurred more than two years ago; (iii) any past arrest or detention not resulting in a conviction; or (iv) any referral to or participation in a pretrial or post trial diversion program. HAWAII residents, you are not required to answer
this question (although you will be required to answer it as to convictions within the past ten years if you receive an offer). KENTUCKY residents, do not respond "Yes" as a result of any misdemeanor conviction where the date of
conviction was more than five years ago. MASSACHUSETTS residents, do not respond "Yes" as a result of any misdemeanor conviction where the date of the conviction or the completion of incarceration, whichever date is later,
occurred more than five years ago. WASHINGTON residents, do not respond "Yes" if your conviction and your release from any time spent in incarceration each occurred more than ten years ago.
2. Are you currently charged with a crime involving, in any way, violence, sex, indecency, stalking, minors, theft, property damage, weapons, dishonesty, fraud, robbery, burglary, or drugs for which
you have not been convicted or that has not been dismissed or otherwise resolved?**
** Residents of ALASKA, CALIFORNIA, HAWAII, ILLINOIS, and RHODE ISLAND, do not answer this question. Residents of OREGON, VIRGINIA, and WASHINGTON, do not answer "Yes" for charges pending longer than one year.
tell us more
1. How often do you get upset? 2. In the past, what did you do when you had a conflict with another person? 3. Which of the following describes your attitude about interviewing? 4. How do you feel when people criticize you? 5. How would people describe how well you deal with change? 6. Which of the following best describes your attendance record in school? 7. How would you respond to a new person at work? 8. How much influence do you have on others? 9. How dependable are you? 10. Compared to other people, how often do you follow safety rules? 11. If we asked people who know you best, how fast would they say you get things done? 12. Compared to others, the amount of effort I put into my work is: 13. If you receive too much change for a purchase, how often would you tell the cashier? agreement (please read, sign, and date below.)
Nature of my Employment. If I am hired by The Franchisee, I agree that I will be an at-will employee, which means that either I or The Franchisee may end my employment at any time, with
or without cause or notice. I agree that no written materials or verbal statements by The Franchisee will constitute an express or implied contract of continued employment and that this at-will
relationship can only be modified in writing by The Franchisee's head of Human Resources. I agree that, if hired, I will obey The Franchisee's rules, including treating confidentially any information
I learn during my employment.
My Participation in The Franchisee's Drug Free Environment. I am not a current user of illegal drugs, and I agree I will never work under the influence of drugs or alcohol.
My Records and References. There is nothing in my background that would cause a risk to The Franchisee's customers, employees, or property. I authorize The Franchisee to conduct reference
checks, criminal and driving records checks, and other consumer report investigations. I release all parties from any liability for providing such information to The Franchisee. In this regard, I
understand that conviction of a crime will not necessarily disqualify me from consideration for employment. I understand that the nature and date of the offense and the relevance of the offense
to the position(s) applied for will determine my eligibility for employment.
Information Certification. I certify that the information I have provided to The Franchisee is true and complete. I agree to notify The Franchisee immediately if I am later charged with any of the
crimes listed above. I agree that any false information or omission allows The Franchisee to refuse to hire me, or to terminate my employment at any time.
The Dispute Resolution Program. If The Franchisee has a Dispute Resolution Program, this application requires you to arbitrate any legal dispute related to your application for employment with
The Franchisee under said Program, which may require mandatory and binding arbitration under the American Arbitration Association "National Rules for the Resolution of Employment Disputes."
Applicant's Signature (typing your name here constitutes a digital signature) Date
Information for Maryland and Massachusetts residents Information for Connecticut residents
