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Team Member Application

Name:              First                        Middle Initial                         Last Name     Date:   10/22/2019
                               Telephone#  

Address:       Street                     Apt                  City                State                Zip
    Date of Birth:
   
                 Driver's License#
    How Long at Address:

Are you 18 years of age or older?   Yes      No
If not, can you provide required proof of eligibility to work?   Yes        No         Not Applicable

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?    Yes       No
(Proof of citizenship or immigration status will be required upon employment.)

Have you ever been convicted of a felony or do you have a current felony charge pending against you?    Yes    No
If Yes, When:           To:         Where:  
Disposition of offenses:  

Have you ever been employed by Captain Jay's?   Yes    No
If Yes, When:           To:         Where:  
Which Captain Jay's location are you applying for?   
Job position applying for:  Cook   Food Prep   Cashier   General Manager   Shift Manager        Years of experience: 
Rate of pay expected:  $   Hourly/Weekly:  Hourly   Weekly          Date available:     
Can you work (check):         
  
Available Monday Tuesday Wednesday Thursday Friday Saturday Sunday


List any relatives working for us now:
  
EDUCATIONAL BACKGROUND
Name of School Location How Many Years Attended? Did You Graduate? Degree Obtained
Grammar

High School

College/University


Employment History:   (List in order, last or present employer first, and account for last 10 years.)
Present or last employer:  
Address:  
Supervisor:                            Telephone#:  
Starting Date:                            Leaving Date:  
Salary or wages:   Starting:                            Final:  
Job Title:                            Reason for leaving:  


Next previous employer:  
Address:  
Supervisor:                            Telephone#:  
Starting Date:                            Leaving Date:  
Salary or wages:   Starting:                            Final:  
Job Title:                            Reason for leaving:  


Next previous employer:  
Address:  
Supervisor:                            Telephone#:  
Starting Date:                            Leaving Date:  
Salary or wages:   Starting:                            Final:  
Job Title:                            Reason for leaving:  

May we contact your present or former employers?   
If not, which one?  

       I, the applicant, understand and agree that:
1.    Under company procedure, a routine inquiry may be made to provide information on my work record.
2.    Employers for whom I have worked in the past may be requested to furnish Captain Jay's information concerning my past employment or activities,
       and I hereby release such employers from my liability in connection therewith.
3.    Any false statement, omission or misrepresentation made in connection with my past record or any other part of my application for employment with
       Captain Jay's will be justification, should I be employed, for my dismissal regardless of when such fact may be discovered.
4.    This position may require me to work various shifts, weekends and holidays and may require me to work a temporary assignment at another restaurant
       location or be transferred.
5.    Certification required - Must obtain Captain Jay's training and certification.
6.    All other tasks as assigned.

       I, the applicant, hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the basis for termination. I hereby authorize Captain Jay's Fish & Chicken to investigate my background inclusive of criminal and verify this information. I understand that if employed, my employment will not be for any fixed period of time and may be terminated by the company at any time. I also authorize Captain Jay's Fish & Chicken to release the information contained herein and its finding and work history of my employment to other forms or persons upon request. I also understand and agree that I may be expected to work on a wide variety of job assignments and agree to accept assignments for which I am qualified as they become available. I also understand my failure to report to Captain Jay's Fish & Chicken for work will indicate I have quit. I also agree to submit to drug screen upon request.

       Warning: Any missing or incorrect information will disqualify you as an applicant.