Fillable Employment Application (Page 2 of 2) in pdf

The Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, E.coli and compylobacter may prevent you from

serving food or handling food equipment in a sanitary or healthy fashion. An essential function of this job involves handling and serving food, food service equipment and utensils in a sanitary and healthy fashion. Is

there any reason why you cannot perform the essential functions of this job?

YES

If yes, explain: ____________________________________________________________________

* DURING THE PAST 7 YEARS, HAVE YOU EVER BEEN CONVICTED OF OR PLED GUILTY TO A CRIME, EXCLUDING MISDEMEANORS AND TRAFFIC VIOLATIONS?

YES

IF YES, DESCRIBE IN FULL ______________________________________________________________________________________ *A conviction will not necessarily bar you from employment.

U.S. MILITARY

Branch of Service __________________________Date Entered ________________Date of Discharge ______________Highest Rank ________________________

Do you have service-related skills and experience applicable to civilian employment?

YES

If yes, Describe ____________________________________

GENERAL

What additional relevant experiences or training have you had other than your work experience, military service and education?

Activities - civic, athletic, fraternal, etc. (Exclude organizations which indicate race, religion, color, or national origin of members.)

MASSACHUSETTS EMPLOYMENT ONLY:

AN APPLICATION FOR EMPLOYMENT WITH A SEALED RECORD ON FILE WITH THE COMMISSIONER OF PROBATION MAY ANSWER ‘NO RECORD’ WITH RESPECT TO ANY INQUIRY HEREIN RELATIVE

TO PRIOR ARRESTS, CRIMINAL COURT APPEARANCES OR CONVICTIONS. IN ADDITION, ANY APPLICANT FOR EMPLOYMENT MAY ANSWER ‘NO RECORD’ WITH RESPECT TO ANY INQUIRY RELATIVE

TO PRIOR ARRESTS, COURT APPEARANCES AND ADJUDICATIONS IN ALL CASES OF DELINQUENCY OR AS A CHILD IN NEED OF SERVICES WHICH DID NOT RESULT IN A COMPLAINT TRANSFERRED

TO THE SUPERIOR COURT FOR CRIMINAL PROSECUTION.

IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS

LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITIES.

MARYLAND EMPLOYMENT ONLY:

UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL

SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR.

1. I certify that I have read and fully completed both sides of this application and that the information contained on this application is correct to the best of my knowledge and

understand that any omission or erroneous information is grounds for dismissal in accordance with the policy of this independent McDonald’s franchise. 2. I authorize the

references listed on this application to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise,

and release all parties from all liability for any damage that may result from furnishing same to you. 3. I acknowledge that this independently owned and operated McDonald’s

franchise reserves the right to amend or modify the policies in its Handbook and other policies of this McDonald’s franchise at any time, without prior notice. These policies do

not create any promises or contractual obligations between this independent McDonald’s franchise and its employees. At this McDonald’s franchise, my employment is at will.

This means I am free to terminate my employment at any time, for any reason, with or without cause, and this McDonald’s franchise retains the same rights. The independent

Owner/Operator of this McDonald’s franchise is the only person who may make an exception to this, and it must be in writing and signed by the Owner/Operator. I understand

that my employer is an independent Owner/Operator of a McDonald’s franchise and that I am not employed by McDonald’s Corporation or any of its subsidiaries. The

independent Owner/Operator of this restaurant is solely responsible for all terms, condition and any other issues concerning my employment. 4. If applicable to my employment,

I have read and understood the notice regarding polygraph tests and my rights under Maryland law.

This independent McDonald’s franchise is an Affirmative Action and Equal Opportunity Employer. Various Federal, State, and Local laws prohibit discrimination on account of

race, color, religion, sex, age, national origin, disability or veterans status. It is this McDonald’s franchise policy to comply fully with these laws, as applicable, and information

requested on this application will not be used for any purpose prohibited by law.

I understand that as a part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation,

personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am

denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the name and address of the reporting

agency that supplies the information.

Signature ____________________________________________ Date __________________

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20% Post-Consumer Content

30% Pre-Consumer Content