Last Name 

Middle Name 

Email    

If you are under 18 years of age, can you provide required proof of your eligibility to work? ... Yes No

Are you prevented from lawfully becoming employed in this country because of your Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.   ... Yes No

 Do you have a valid Drivers License? ... Yes No  If yes, please provide State and Number:

State    ... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY   Number 

Date available to work?             

Are you able to work: 

Evenings ... Yes No Weekends ... Yes No Holidays ... Yes No  

Have you ever been convicted of a felony?  

Employment History

May we contact your present employer?     

Most Recent Employer  

Telephone    

Date Started  

Starting Salary  

Starting Position       

Date Left

Salary upon Leaving  

Position upon Leaving      

Name of Supervisor     

Title of Supervisor                         

Reason for Leaving  

Description of Duties   

Employer  

Telephone     

Date Started 

Description of Duties   

Employer  

Education

Note to Applicants:

DO NOT ANSWER THE FOLLOWING QUESTION UNLESS YOU HAVE REVIEWED THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING, PLEASE SEE JOB DESCRIPTION.

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge and that I have not knowingly withheld any fact or circumstance. I understand that falsifying or omitting information on this form may cause me to be disqualified from further consideration or dismissed from employment if hired.

This application for employment shall be considered active for a period of 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

All employment offers are made contingent upon satisfactory proof of legal authorization to work in the United States according to the law. I understand that failure to provide satisfactory proof of identity and authorization to work in the United States will disqualify me from employment.

This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer is authorized to make assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by someone with A New Taste Sensation.

I understand that if hired, I may be required to undergo a physical examination, have a photograph taken, and drug and alcohol test if my job requires driving, or if I should become involved in an accident while on duty, on company premises, on job sites, or in a company vehicle, or if a reasonable suspicion of drug or alcohol use exists based on my performance, appearance, an/or behavior. The examination and the test will be performed at the employer’s expense, by the employer’s representative.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employee or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organization for furnishing information about me.

I acknowledge that I have read this authorization and release, fully understand it, and fully and voluntarily agree to its provisions.

By typing your name and dating in the boxes below you are acknowledging the authorization and release and fully and voluntarily agree to the provisions of this application.