Yours Truly Restaurants

Application for Employment

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including but not limited to race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

Position Applying For

Have You Ever Applied To Yours Truly Before? (Please State Where And When.)

Location(s) Applying For

Beachwood: Chagrin Falls: Hudson: Mayfield: Mentor: Shaker Square: Medina: Rockside:

IDENTIFICATION - PERSONAL INFORMATION

Last Name

First Name

Middle

Present Address (street, city, state, zip code)

Previous Address (street, city, state, zip code)

Permanent Address (street, city, state, zip code)

Date of Birth (If under 21)

Home Phone

Other Phone Contact

e-mail Address

GENERAL INFORMATION

List Business and Professional Organizations of Which You Are a Member. (Omit those indicating race, creed, color, sex, age, handicap, national origin or other protected group.)

List Leisure Activities, Hobbies, Recreational Interest. (Omit those indicating race, creed, color, sex, age, handicap, national origin or other protected group.)

Have You Ever Been Convicted of a Felony Which is Related to the Functions or Qualifications of the Position for Which You Are Applying? This Question Does Not Apply To Convictions Which Have Been Sealed or Expunged. (A conviction record will not necessarily be a bar to employment.)

Yes No

If Yes, Please Describe Fully The Felony Convictions Listing The Nature of The Offense(s) And Your Rehabilitation Since The Conviction(s).

How Many Days Have You Been Absent From Work In The Last 12 Months For Any Reason? Please Explain:

How Many Days Have You Been Late For Work In The Last 12 Months For Any Reason? Please Explain:

List Office Skills/Machines You Can Operate:

What Are Your Plans for The Next 24 Months (school, work, travel, etc.):

EDUCATION
High School
School Name	Location	Did You Graduate?
		Yes No
Degree	Major/Minor	Grade Average

College
School Name	Location	Did You Graduate?
		Yes No
Degree	Major/Minor	Grade Average

College
School Name	Location	Did You Graduate?
		Yes No
Degree	Major/Minor	Grade Average

Business/Technical
School Name	Location	Did You Graduate?
		Yes No
Degree	Major/Minor	Grade Average

Other
School Name	Location	Did You Graduate?
		Yes No
Degree	Major/Minor	Grade Average

List Extra Curricular Activities, Academic Awards, Honor Societies, Etc. (Omit those indicating race, creed, color, sex, age, handicap, national origin or other protected group.):

If a Minor, Can You Produce the Age/Work Certificate Necessary To Obtain Employment? Yes No
Are You Able, at the Time of Employment, to Submit Verification of Your Legal Right to Work In The U.S.? Verification and Completion of the I-9 Form Must Be Submitted No Later Than Three Business Days After Date of Hire. Yes No

EMPLOYMENT INFORMATION (List all jobs and activities which indicate your qualifications including military service, schools, part-time employment while in school, self employment and periods of unemployment for the past 5 years. Please also list significant experience more than 5 years ago. Begin with most recent. Do not indicate "see resume.")
Full Name of Present or Last Employer	Nature of Business	Employment Dates (Month & Year)

Address (Street, City, State, Zip Code)		Salary

Your Position and Duties		Reason for Leaving

Name and Title of Immediate Supervisor	Area Code/Phone Number


Full Name of Previous Employer	Nature of Business	Employment Dates (Month & Year)

Address (Street, City, State, Zip Code)		Salary

Your Position and Duties		Reason for Leaving

Name and Title of Immediate Supervisor	Area Code/Phone Number


Full Name of Previous Employer	Nature of Business	Employment Dates (Month & Year)

Address (Street, City, State, Zip Code)		Salary

Your Position and Duties		Reason for Leaving

Name and Title of Immediate Supervisor	Area Code/Phone Number

May We Contact Your Present Employer? Yes No
Weekly Schedule Restrictions	Salary Expected	When Would You Be Able to Report to Work?

As a Potential Employee What is Your Greatest Strength?

As a Potential Employee What is Your Greatest Weakness?

Please State Why You Are Seeking Employment With Yours Truly Restaurants. If Obtained, How Will Your Work Help In Fulfilling Personal Goals.

BUSINESS REFERENCES (List persons we may contact who have contributed to your success.)
Full Name	Organization	Title	How Long Known?

Home Address (street, city, state, zip code)		Home Phone	Business Phone


Full Name	Organization	Title	How Long Known?

Home Address (street, city, state, zip code)		Home Phone	Business Phone

In submitting this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the provision and use of such information. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand and agree that, if employed by this organization, I will abide by its rules and regulations which I understand are subject o change. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.

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