Application For Employment

Introduction

APPLICATION FOR EMPLOYMENT

6 4 Fun LLC
d/b/a The Amazing Pizza Machine

This application will be kept on active file for 30 days. If you are not hired during that time period, but wish to continue to be considered for available positions, you must complete a new application.

THE COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER AND BELIEVES STRONGLY IN THE PRINCIPLES OF NON-DISCRIMINATION. NO ACTION WILL BE TAKEN OR WITHHELD ON THE BASIS OF RACE, COLOR, RELIGION, SEX, DISABILITY, NATIONAL ORIGIN, AGE (40 or older), GENETIC INFORMATION, VETERAN'S STATUS, MARITAL STATUS, OR ANY OTHER LEGALLY RECOGNIZED PROTECTED BASIS UNDER FEDERAL, STATE, OR LOCAL LAWS, REGULATIONS, OR ORDINANCES.

APPLICANTS WITH DISABILITIES MAY BE ENTITLED TO REASONABLE ACCOMMODATION UNDER THE TERMS OF THE AMERICANS WITH DISABILITIES ACT, NEBRASKA FAIR EMPLOYMENT PRACTICE ACT, AND LOCAL LAWS. A REASONABLE ACCOMMODATION IS A CHANGE IN THE WAY THINGS ARE NORMALLY DONE WHICH ENSURE AN EQUAL EMPLOYMENT OPPORTUNITY WITHOUT IMPOSING UNDUE HARDSHIP ON THE COMPANY. PLEASE INFORM THE COMPANY'S REPRESENTATIVE IF YOU NEED ASSISTANCE COMPLETING ANY FORMS OR TO OTHERWISE PARTICIPATE IN THE APPLICATION PROCESS.

Drug-Free Workplace – We Test for Drugs

Contact Information

Other Names

Please include all other names by which you have been known.

Disclosures

This Company requires all employees to be at least 15 years old. The Fair Labor Standards Act requires that employees be at least 18 years old to work in jobs declared hazardous by the Secretary of Labor.

In addition, employees serving or selling alcoholic beverages in Nebraska must be at least 19 years of age.

Are you at least 15 years of age?

Yes No

Are you 16 or 17 years of age?

Yes No

Are you 18 years of age?

Yes No

Are you authorized to work in the United States?

Yes No

The company performs background checks on all applicants who receive a job offer. Will you authorize the company to conduct a background investigation?

Yes No

Are you able to work nights and weekends?

Yes No

Have you applied for employment with us in the last 6 months?

Yes No

Have you been interviewed for a position with us in the last 6 months?

Yes No

Have you been employed by the company before?

Yes No

Have you ever been asked to resign, been dismissed or discharged/terminated from a job?

Yes No

Are you aware of the essential functions and job duties of the position(s) for which you are applying?

Yes No

Are you physically and mentally able to perform the essential functions and job duties of the position(s) for which you are applying, with or without accommodation?

Yes No

Criminal Conviction Disclosure

Conviction Disclosure

A conviction record is not an automatic bar to employment. Each case will be considered with regard to factors such as age at time of offense, seriousness, nature of the violation, and rehabilitation.

You are not required to disclosed a sealed juvenile record, which includes records of: An arrest, being taken into custody, a complaint, disposition of a case, diversion or adjudication of a criminal charge, or a sentence following conviction.

Address History

Have you lived at your Current Address for the last 10 years?

Your Skills

	Typing	Words Per Minute:
	Computer (General)
	Microsoft Word
	Microsoft Outlook
	Microsoft Excel
	Microsoft Powerpoint
	Microsoft Access
	Microsoft Office Suite
https://secure.careerlink.com/staff/application/edit/0923/0003
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Language Skills

What languages do you speak, read or write fluently?

Language	Speak	Read	Write	Action

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Referral Sources

How did you first hear about this position?

* Detail:

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What date are you available to start work?

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“How many days per week would you prefer to be scheduled

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What employment status are you applying for?

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Full Time Part Time Seasonal On Call/Casual Temporary

Desired Schedule

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Weekday		From	To	A check next to a day indicates that you are available to work any time on that day. A "from" time next to a day indicates that you can start work (be on-site) at the specified time. A "to" time next to a day indicates that you must stop work by the time indicated. Make sure to add "am" or "pm" if there's any chance some of the times might be confusing without it.
	Sunday
	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

Preferred minimum hours per week:
Preferred maximum hours per week:

Additional information about your work schedule, such as limitations:

Employment Experience

Please list all of your employers for the last 5 years. Failure to list current or prior employers may disqualify you from being eligible for hire.

Do you have prior work experience?

Job Interests

Type of Position Desired (Select All Applicable) - NOTE: You must be 18 or 19 or older to be considered for certain positions

Resume

Professional References

Please include 3 references.

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CONSENT TO PROVIDE EMPLOYMENT HISTORY TO PROSPECTIVE EMPLOYER

NEBRASKA REV. STATUTE 48-201 GOVERNS THE SPECIFIC AUTHORIZATIONS/PERMISSIONS/LIMITATIONS OF THIS CONSENT.

I HEREBY GIVE CONSENT TO ANY AND ALL EMPLOYERS OF MINE TO PROVIDE INFORMATION WITH REGARD TO MY EMPLOYMENT WITH MY PRIOR EMPLOYERS TO THE COMPANY. THIS CONSENT IS VALID FOR SIX MONTHS FROM THE DATE OF MY SIGNATURE BELOW. I CONSENT TO THE DISCLOSURE OF THE FOLLOWING INFORMATION ABOUT ME BY ANY AND ALL OF MY PRIOR EMPLOYERS:

1. DATE AND DURATION OF EMPLOYMENT;

2. PAY RATE AND WAGE HISTORY ON THE DATE OF RECEIPT OF THIS WRITTEN CONSENT;

3. JOB DESCRIPTIONS AND DUTIES;

4. THE MOST RECENT WRITTEN PERFORMANCE EVALUATION PREPARED PRIOR TO THE DATE OF THE REQUEST FOR INFORMATION AND PROVIDED TO ME DURING THE COURSE OF MY EMPLOYMENT;

5. ATTENDANCE INFORMATION;

6. RESULTS OF DRUG OR ALCOHOL TESTS ADMINISTERED WITHIN ONE YEAR PRIOR TO THE REQUEST FOR INFORMATION;

7. THREATS OF VIOLENCE, HARASSING ACTS, OR THREATENING BEHAVIOR RELATED TO THE WORKPLACE OR DIRECTED AT ANOTHER EMPLOYEE;

8. WHETHER I WAS VOLUNTARILY OR INVOLUNTARILY SEPARATED FROM EMPLOYMENT AND THE REASONS FOR SEPARATION; AND

9. WHETHER I AM ELIGIBLE FOR REHIRE.

Signature

PLEASE READ CAREFULLY BEFORE SIGNING

I certify that the information contained in this application is true, to the best of my knowledge, and I understand that any misrepresentation or willful omission of facts may result in rejection of my application or termination of my employment.

I hereby authorize the Company to deduct, withhold, or divert from my wages any amounts necessary to offset any damages caused by me or the value of any property or money entrusted to me or owed by me to the Company during the course of my employment with the Company, provided that it does not cause me to receive less than the minimum hourly wage required by state and federal laws.

I agree that I will settle any and all previously unasserted claims, disputes, or controversies arising out of our relating to my application for candidacy for employment, employment, and/or cessation of employment with the Company by final and binding arbitration before a neutral arbitrator.

By way of example only, such claims include claims under federal, state, and local statutory or common law, such as Age Discrimination in Employment Act, Title VII of the Civil Rights Act of 1964, as amended, including the Amendments of the Civil Rights Act of 1991, the Americans with Disabilities Act, the Law of Contract, and the Law of Tort.

I hereby certify that, if employed, I will report to my manager or other member of management if I am ever harassed by someone in the Company or if I ever become aware of any unethical behavior by any employee of the Company.

I expressly understand and agree that if employed, my employment (having no specified term), is "at will" and thus is based upon mutual consent and may be terminated at will, with or without cause, by either party (Company or me) without prior notice to the other. I understand that if I want to leave in good standing, I must provide two weeks notice to my supervisor before terminating my employment.

Signature

Submit Application

Save application and come back later: If you would like to save your progress and finish at a later time, click the "Save for Later" button below. You will receive an email containing the link to your incomplete application.

Submit Application: If you are ready to submit your application for consideration, click the button below. The server will check to make sure the application is complete before accepting it for delivery. If you included your valid email address, you will receive an email confirming receipt. Once your application has been accepted, you will receive a confirmation code. If you have any problems, please include the confirmation code in any correspondance. The confirmation code is proof that your application was accepted for submission.

Your application has not been submitted.

Printing Your Application: Once the application has been submitted, you will be given a confirmation code, and we would advise printing at that time.

Your Name:	Error:
Address:	Error:
Primary Phone:	Error:
Alternate Phone:	Error:
Email:	Error:
Re-type Email:

Previous Name:	ERROR:
Date of Change:
You will be provided additional space as needed.

Company:
Position/Title:
Approximate date:
Explanation:

Date of Conviction:	ERROR:
Type:	Felony Misdemeanor Arrest
Location of Conviction:
Explanation:
You will be provided additional space as needed.

Address:	ERROR:
From:	(Address will be sorted by this date automatically)
To:
You will be provided additional space as needed.

Position for which you Applied:
Approximate Date of Application:

Position for which you Interviewed:
Approximate Date of Interview:

Position in which you were employed:
Approximate Date of Employment:

Reference Name:	ERROR:
Phone:
Contact Method Required
Relationship to You:
Years Known: