Employment Application
Employment Application
Print Form
Date:
Name: First, MI, Last Address: City & State:
Complete & return in person to:
Wilson Avenue Dairy Queen 11 Wilson Ave. Dr. SW Cedar Rapids, IA 52404
Phone: (319) 364-7888
Zip Code: SS Number:
I am: (Please check a box) A Citizen or National of the United States
Home Phone: Please include area code Cell Phone: Please include area code
An Alien lawfully admitted for Permanent Residence An Alien authorized to work in the United States
Email:
Alien Number
Are you 18 or older? Yes
No If no, D.O.B.
Expiration
Who referred you to this job?
Date available to begin work?
Hours available to work:
Mon
Tue
Full time
Wed
Part-time Thu
Full or part-time
Summer Only
Fri
Sat
Sun
am pm
to
am pm
to
am pm
to
am pm
to
am pm
to
am pm
to
am pm
to
Education:
am pm
Highest Grade
Completed
am
pm
7
Post Secondary
Grade Point Average
am pm
Please list any activities you are involved in that may interfere with your
am pm
work schedule:
am pm
am pm
am pm
Have you ever worked for Dairy Queen before?
Yes
No If yes, date:
If yes, location:
If yes, please list your duties:
Have you ever been convicted for a crime other than a minor traffic violation? Yes
No If yes, please explain below:
Continue on the next page
Previous Employment
Name of last employer: Name of last supervisor:
Dates of employment:
From:
To:
Salary:
From:
To:
Complete Address: Phone #: Last job title: Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact your employer: Yes No
Who would we contact in case of an emergency? Name:
Home Phone:
Work/Cell Phone:
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 for employment can lead to rejection of my application or dismissal from employment, whenever discovered. I also authorize the store owner to request references from my former employers.
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 of for 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 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 and that the store owner would retain a similar right.
I Hereby attest that all statements made by me above are true to the best of my knowledge.
Applicant Signature: Manager Signature:
Date: Date:
................
................
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