Application for Employment Leave this field empty Date: Position Applied for: Personal Data: First Name Middle Name Last Name Mailing Address City State Zip Email Address Home Phone Work Phone Cell Phone How did you hear about this opening? Salary Requirement: Which will you accept: *Check all that apply) Full Time? Part Time? Seasonal? Shift work? Are you over 18 years old? Yes No Are you eligible to work in the United States? Yes No (either because you are a U.S. Citizen or have U.S. government permission to do so) NOTE: If offered employment you will be required to provide documentation to verify employment eligibility. Failure to provide the requested documentation may result in a determination that the applicant is ineligible for employment in the United States. Have you ever worked for us before? Yes No If yes, When & Where? Give name, relationship and department of any relatives employed by Rhinehart's Oyster Bar: Driver's History Information: Do you have a valid Driver's License: Yes No Class: State: Have you received any traffic violations in the past 5 years? Yes No If yes, list type of offense and dates: Criminal History Information: Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a misdemeanor? (For example: DUI, Bad Checks, etc) Yes No (Omit non-moving traffic violations/parking tickets and any offense which was finally adjudicated in a Juvenile Court or under a Youth Offender Law) If YES describe the circumstances. (Date, Place, Charges, Disposition). Have you (since the age of 18) ever been convicted of or plead guilty or no contest to a felony? Yes No If Yes, describe the circumstances: (Date, Place, Charges, Disposition) NOTE: Applicants convicted of a criminal offense involving the manufacture, distribution, trafficking, or sale of a controlled substance, dangerous drugs or marijuana, or convicted of any felony involving a violent crime such as assault with a deadly weapon, aggravated assault or murder are ineligible to be employed with Rhinehart's Oyster Bar. Such applicants will automatically be rejected. Applicants convicted of any other felony shall be considered on a case by case basis. An applicant convicted of a felony or misdemeanor who has received a pardon from the appropriate State Pardons and Parole Board shall be eligible for employment with Rhinehart's Oyster Bar. Have you ever been suspended, demoted, dismissed or asked to resign from any job? Yes No If Yes, explain in detail Education: High School Name Address (Name of the high school of state authority issuing the diploma or certificate) Check highest grade completed: 7th 8th 9th 10th 11th 12th Graduated? Yes No If no, do you have GED? Yes No Colleges/Universities Please complete the following for post-secondary education (Technical Schools/Colleges/Universities): Name of School City/State No. of Hours Degree Type Earned Yes No Yes No Yes No Skills/Training Describe specialized training, qualifications, apprenticeship, skills and extra-curricular activities which relate to the position for which you are applying. Include office equipment, computer skills, foreign language skills, typing skills, and business equipment or machine operating skills which may relate to the position for which you are applying. References: Give names, addresses, and telephone numbers of three (3) references that ARE NOT related to you and ARE NOT previous employers. Name Phone Street Address City State Zip Name Phone Street Address City State Zip Name Phone Street Address City State Zip Name Phone Street Address City State Zip Employment History: Describe your work history beginning with your current or most recent job. Include military and volunteer experience and periods of unemployment. Failure to give complete information regarding each job held may result in your disqualification. Complete addresses with zip codes and telephone numbers for all employers are necessary. A resume may be attached only as additional information and will not be accepted in lieu of completing this section. Name of Organization or Firm Phone Number Street Address Employed from month/year City State Zip Employed to month/year Name of your supervisor Pay at Start Official job title Pay at End Reason for Leaving Describe Your Specific Job Duties: Name of Organization or Firm Phone Number Street Address Employed from month/year City State Zip Employed to month/year Name of your supervisor Pay at Start Official job title Pay at End Reason for Leaving Describe Your Specific Job Duties: Name of Organization or Firm Phone Number Street Address Employed from month/year City State Zip Employed to month/year Name of your supervisor Pay at Start Official job title Pay at End Reason for Leaving Describe Your Specific Job Duties: Name of Organization or Firm Phone Number Street Address Employed from month/year City State Zip Employed to month/year Name of your supervisor Pay at Start Official job title Pay at End Reason for Leaving Describe Your Specific Job Duties: Please use this space for additional information pertinent to your education, training and experience: Authorization to Release Information Conditions of Employment I have made application for employment with Rhinehart's Oyster Bar. I authorize any persons or organizations to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, whether or not it is in their records, with regard to any of the subjects covered by this application, and I release all such parties from all liability for any damage whatsoever for issuing same. Furthermore, if I am employed by Rhinehart's Oyster Bar, I agree to the policies, rules, orders and regulations of the government set forth in Rhinehart's Oyster Bar's Personnel system, employee handbook, policies and procedures and ordinances; and acknowledge that these policies and procedures, rules, and regulations may be changed, interpreted, withdrawn, or added to by Rhinehart's Oyster Bar at any time. I further acknowledge that if I become employed with Rhinehart's Oyster Bar, my employment will be at -will and may be terminated with or without cause at any time by me or Rhinehart's Oyster Bar until such time that I am no longer on my initial trial period, and become a regular status employee. If required by Rhinehart's Oyster Bar for the position which I am applying, I consent to undergo a drug test, a physical examination, and/or a psychological examination after I have received a conditional offer of employment, as deemed necessary. THIS APPLICATION WILL REMAIN ACTIVE FOR NINETY (90) DAYS ONLY. Should you become an employee with Rhinehart's Oyster Bar, your position may require random drug testing. May we contact your present employer? Yes No Not presently employed By checking this box you are agreeing to this authorization to contact prior employers. You must check this box even though if you have chosen for us not to contact your present employer. Alcohol and Controlled Substance Testing As a condition of employment with Rhinehart's Oyster Bar, you may be required to submit to an alcohol and controlled substance test. Employees who test positive for illegal drugs and/or alcohol will be terminated. Employees must report any conviction under a criminal drug statute for such violations. A report of the conviction must be made within five (5) days after the conviction. By checking this box, I acknowledge the above and consent to such an examination and test. Applicant's Certification and Agreement I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I am aware that the falsification of this application or the omission of complete information will result in disqualification, or upon discovery, termination of employment. Rhinehart's Oyster Bar is hereby authorized to make any investigation of my prior educational and work history. Finally, I agree that all records generated for purposes of employment are property of and shall remain the sole and exclusive property of Rhinehart's Oyster Bar. By checking this box, I acknowledge the above and agree to these terms. Resumes, letters of reference, etc. submitted with the application become property of Rhinehart's Oyster Bar and will not be returned. The information you have provided on the application is subject to public disclosure under the Georgia Open Records Act. Applicant's Certification of Employment Eligibility I certify that I am in compliance with O.C.G.A. 13-10-91 and that I am a citizen, legal permanent resident or a qualified alien or nonimmigrant and I am eligible to work in the United States. By checking this box, I acknowledge the above and agree to these terms. Attach Resume to Email:
