Copy of Online Application — Mike Andersons Restaurant

STEP ONE

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other legally protected status.

Date

Today’s Date

YYYY

Position(s) Applied For

How did you find out about this job?

Internet

M.A. Team Member

Walk-In

Relative

Other

If you selected other above, please specify:

Have you interviewed with us before and/or filled out the personality survey previously?

Yes

If you answered yes, what position?

Are you seeking full time, part time, or temporary employment?

Full Time

Part Time

Temporary

Availability

Please provide your availability for each day of the week and list the shift you can work: (B)reakfast (L)unch (D)inner)

APPLICANT INFORMATION

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

What days, hours, and shift(s) would you prefer to work?

List day and/or times you are not available to work?

Are you willing to work the following:

(Please select appropriate answer if yes)

Overtime?

Weekends?

Holidays?

Sundays?

Are you currently employed?

Yes

If hired, when would you be able to start?

YYYY

If hired, do you have a reliable means of transportation to get to work?

Explain:

Are you at least 18 years old?

Yes

If you are under 18 years of age, can you furnish a work permit?

Yes

Are you legally eligible for employment in the U.S.?

(Proof of U.S. citizenship or immigration status is required if hired.)

Yes

Have you ever pled “guilty” or “no contest” to or been convicted of a crime?

Yes

If yes, state the nature of the offense and disposition of the case, please include dates and details. (PLEASE NOTE: Answering “yes” to this question does not constitute an automatic bar to employment. Factors such as the date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.)

SPECIAL SKILLS, QUALIFICATIONS & CONSIDERATIONS

Summarize special skills, talents, and qualifications, volunteer activities, military experience, employment or other activities related to and may assist you in the job you are applying for:

Elementary Education

(Please select highest level achieved)

Name & location of Elementary School

Secondary Education

(Please select highest level achieved)

Name & location of Secodary School

College or University

(Please select highest level achieved)

Name & location of College or University

Degree & Major

Minor

Personal References

Please list any friends or relatives that are currently or have been employed by this company:

Please list up to (4) Personal References

(Please include Name, Relationship, Years Known & Phone Number)

Have you ever been suspended, discharged (fired), or asked to resign from any previous employer?

Yes

If yes, please explain:

WORK HISTORY

(Please begin with most to least recent employment)

1. Company Name

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company Phone Number

(###)

###

####

Job Title

Salary

(Please list beginning & ending salary)

Supervisors Name & Job Title

Briefly describe Duties/Responsibilities/Accomplishments

Specific Reason for Leaving

2. Company Name

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company Phone Number

(###)

###

####

Job Title

Salary

(Please list beginning & ending salary)

Supervisors Name & Job Title

Briefly describe Duties/Responsibilities/Accomplishments

Specific Reason for Leaving

3. Company Name

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company Phone Number

(###)

###

####

Job Title

Salary

(Please list beginning & ending salary)

Supervisors Name & Job Title

Briefly describe Duties/Responsibilities/Accomplishments

Specific Reason for Leaving

Have you worked for any of these organizations or attended school under a different name?

Yes

If yes, give name and organization(s):

May we contact all of the employers listed above?

Yes

If not, list the employers you do not wish us to contact and why:

Authorizations & At-Will Employment Agreement (please read carefully, then sign and date below)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired. I authorize this company to make an investigation of all information contained in this employment application and I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations. I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. AT-WILL EMPLOYMENT AGREEMENT I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.

Name

First Name

Last Name

I hereby agree to the conditions stated above and the digital name listed herein serves as my personal signature.

Agree

Date of Signature

YYYY

Thank you for applying for a position with Mike Anderson’s Seafood. A representative will contact you if there is a position available.

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BATON ROUGE

Mike Anderson’s Seafood Team Member Application