` Kelber Employment Form : Kelber Catering

Application For Employment: Super Bowl Bartenders

Pre-Employment Questionnaire. An Equal Opportunity Employer.

PERSONAL INFORMATION

NAME (LAST NAME FIRST)
SOCIAL SECURITY NUMBER
PRESENT ADDRESS
APT. NO.
CITY
STATE
ZIP
PERMANENT ADDRESS
APT. NO.
CITY
STATE
ZIP
PREVIOUS ADDRESS IF LESS THAN 3 YEARS
APT. NO.
CITY
STATE
ZIP
ARE YOU 18 YEARS OR OLDER?
YES NO
PHONE
ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?
YES NO
EMAIL ADDRESS
CELL PHONE
 

DESIRED EMPLOYMENT

POSITION
DATE YOU CAN START
SALARY DESIRED
ARE YOU EMPLOYED NOW?
Yes No
IF SO MAY WE CONTACT YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
Yes No
WHERE?
WHEN?
EVER WORKED FOR THIS COMPANY BEFORE?
Yes No
WHERE?
WHEN?
REASON FOR LEAVING
NAME OF SUPERVISOR AT THIS COMPANY
WHO REFERRED YOU TO THIS COMPANY? (HOW DID YOU FIND OUT ABOUT THIS POSITION?)
EMPLOYMENT AGENCY NEWSPAPER ADVERTISING ONLINE AD
STATE EMPLOYMENT OFFICE COLLEGE PLACEMENT SERVICE WALK IN OTHER
AVAILABILITY
WEEKDAYS:
MORNING DAY EVENING

WEEKENDS:
MORNING DAY EVENING

FULL TIME PART TIME SEASONAL SPRING TO FALL SEASONAL FALL TO SPRING

EDUCATION

SCHOOL LEVEL
NAME AND LOCATION OF SCHOOL
NO. OF YEARS ATTENDED
DID YOU GRADATE
SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL

GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
SPECIAL TRAINING
SPECIAL SKILLS

FORMER EMPLOYERS

LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT

NAME OF PRESENT OR LAST EMPLOYER
ADDRESS

CITY
STATE
ZIP
STARTING DATE
LEAVING DATE
JOB TITLE
WEEKLY STARTING SALARY
WEEKLY FINAL SALARY
MAY WE CONTACT YOUR SUPERVISOR?
Yes No
NAME OF SUPERVISOR
TITLE
PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

NAME OF PREVIOUS EMPLOYER
ADDRESS

CITY
STATE
ZIP
STARTING DATE
LEAVING DATE
JOB TITLE
WEEKLY STARTING SALARY
WEEKLY FINAL SALARY
MAY WE CONTACT YOUR SUPERVISOR?
Yes No
NAME OF SUPERVISOR
TITLE
PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

NAME OF PREVIOUS EMPLOYER
ADDRESS

CITY
STATE
ZIP
STARTING DATE
LEAVING DATE
JOB TITLE
WEEKLY STARTING SALARY
WEEKLY FINAL SALARY
MAY WE CONTACT YOUR SUPERVISOR?
Yes No
NAME OF SUPERVISOR
TITLE
PHONE
DESCRIPTION OF WORK
REASON FOR LEAVING

REFERENCES

BELOW, GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOW AT LEAST ONE YEAR.

NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED

SERVICE RECORD

HAVE YOU EVER SERVED IN THE U.S. ARMED FORCES? Yes No
BRANCH OF SERVICE
DISCHARGE DATE RANK

AUTHORIZATION

"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

"I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HERIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.

"I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE.

"THIS WAIVER DOES NOT PERMIT THE RELEASE OR USE OF DISABILITY-RELATED OR MEDICAL INFORMATION IN A MANNER PROHIBITED BY THE AMERICANS WITH DISABILITIES ACT (ADA) AND OTHER RELEVANT FEDERAL AND STATE LAWS."


DATE
NAME

TO ALL APPLICANTS:

Kelber Catering, Inc. complies with all equal employment opportunity affirmative action laws and regulations. Employment decisions are made on the basis of job-related criteria witout regard to race, color, religion, sex, sexual preference, marital status, age or national origin. Similarly, these considerations will be applied in the employment of qualified handicapped individuals, disabled veterans and Vietnam Era Veterans.

To maintain accurate data for our affirmative action program, we request that you complete any of the voluntary sections that apply to you. You will not be subject to adverse treatment either by providing the information or by failing to complete the sections.

This sheet will be retained in a confidential file separate from your personal records. Its only purpose is to assist us in preparing reports for corporate and governmental monitoring activities. If you want more information about any of the sections, please check with a Kelber Catering employment representative.

GENERAL EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION DATA

Name
Date
Address
City
State
Zip
Type of work you are applying for:

RACIAL/ETHNIC GROUP SELF-IDENTIFICATION

Gender
Black
All persons having origins in any of the Black racial groups of Africa
Hispanic
All persons of Mexican, Puerto Rican, Cuban, Central and South America or other Spanish Culture
Asian, Pacific Islander
Southwest Asia, India, China, Japan, Korea, etc.
American Indian or Alaskan Native
People who maintain cultural identification through tribal affiliation or community recognition
White (Not of Hispanic orgin)/Other
Europe, North Africa, Middle East
If your heritage is not described in any of the above categories, then mark this group.

DISABLITY STATUS
Do you claim disablity Status?
Yes No
VETERANS/U.S. MILITARY STAUS
Are you a Vietnam Era Veteran?
Yes No

I certify that I understand the about information is voluntary and will be kept confidential. I understand that false statements made in any of the above sections may be grounds for denial of employment or discharge.
Name
Date

For more information contact:

Thérèse VanBlarcom
Director of Human Resources
612.335.6340

Melissa M. Hare
HR and Payroll Manager
612.335.6158

Please send resumes to: applications@kelber.com