Employment Application

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Date of Application

Personal Data

000-000-0000 or (000) 000-0000

Job Details

$xx per hour


Monday Availability (select all that apply)
Tuesday Availability (select all that apply)
Wednesday Availability (select all that apply)
Thursday Availability (select all that apply)
Friday Availability (select all that apply)
Saturday Availability (select all that apply)
Sunday Availability (select all that apply)
Have you ever worked for Hickory Flat Kitchen?
Do you have any relatives or friends currently working for Hickory Flat Kitchen
Do you have reliable transportation to and from work? (Required)

Do you have any physical, mental, or medical impairment that would interfere with your ability to perform the essential duties of this job with or without an accommodation? If “Yes”, please describe in full. (Refer to position description if necessary)

Are you able to submit verification of your legal right to work in the U.S.?

Verification and completion of Form I-9 must be submitted no later than 3 business days after date of hire

Employment History

Employer 1

Start Date

End Date

Employer 2

Start Date

End Date


Have you ever been counseled or disciplined for cash handling violations?

Cash handling violations

Have you ever been counseled, disciplined or terminated for theft, violence, discrimination, or harassment?

Theft, violence, discrimination, or harassment

Security Data

Within the past 10 years, have you ever been convicted of a felony, entered a plea of nolo to a felony charge or been convicted of a misdemeanor?

* A yes answer does not automatically disqualify you for employment. All individual circumstances may be considered.

Record of Education

High School




I authorize investigation of all statements and references contained in this employment application as may be necessary in arriving at an employment decision, including requests for criminal or credit reports. I understand that incorrect, misleading, falsified or omission of information on this application may result in disqualification from consideration of employment or immediate termination of employment. I understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs during employment.

I agree to the statement above.