Employment Application Date: Name: First, MI, Last Address: City & State: Zip Code: SS Number: Home Phone: Please include area code Cell Phone: Please include area code A Citizen or National of the United States I am: (Please check a box) An Alien lawfully admitted for Permanent Residence An Alien authorized to work in the United States Full time Part-time Full or part-time Summer Only Have you ever worked for Dairy Queen before? If yes, please explain below: No Yes Have you ever been convicted for a crime other than a minor traffic violation? Continue on the next page Yes No Email: Alien Number Expiration Wilson Avenue Dairy Queen 11 Wilson Ave. Dr. SW Cedar Rapids, IA 52404 Phone: (319) 364-7888 www.dairyqueen9.com If no, D.O.B. Date available to begin work? Who referred you to this job? to am pm am pm Mon to am pm am pm Sun to am pm am pm Sat to am pm am pm Fri to am pm am pm Thu to am pm am pm Wed to am pm am pm Tue Hours available to work: Are you 18 or older? Education: Highest Grade Completed Post Secondary Grade Point Average Please list any activities you are involved in that may interfere with your work schedule: Yes No If yes, date: If yes, location: If yes, please list your duties: Complete & return in person to:
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Employment Application - Dairy Queen you ever worked for Dairy Queen before? ... I understand that nothing contained in this employment application or in the granting of an interview
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Employment ApplicationDate:
Name: First, MI, Last
Address:
City & State:
Zip Code:
SS Number:
Home Phone: Please include area code
Cell Phone: Please include area code
A Citizen or National of the United States
I am: (Please check a box)
An Alien lawfully admitted for Permanent Residence
An Alien authorized to work in the United States
Full time
Part-time
Full or part-time
Summer Only
Have you ever worked for Dairy Queen before?
If yes, please explain below:NoYesHave you ever been convicted for a crime other than a minor traffic violation?
Continue on the next page
Yes No
Email: Alien Number
Expiration
Wilson Avenue Dairy Queen 11 Wilson Ave. Dr. SW
Cedar Rapids, IA 52404
Phone: (319) 364-7888 www.dairyqueen9.com
If no, D.O.B.
Date available to begin work?
Who referred you to this job?
toampm
ampm Mon
toampm
ampm Sun
toampm
ampm Sat
toampm
ampm Fri
toampm
ampm Thu
toampm
ampm Wed
toampm
ampm Tue
Hours available to work:
Are you 18 or older?
Education:
Highest Grade Completed Post Secondary Grade Point Average
Please list any activities you are involved in that may interfere with your work schedule:
Yes No If yes, date: If yes, location:
If yes, please list your duties:
Complete & return in person to:
Name:
Who would we contact in case of an emergency?
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: Date:
Manager Signature: Date:
Complete Address:
Name of last employer:
Name of last supervisor:
Dates of employment:
From: To:
Salary:
From: To:
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: