Form App-Hr - Kfc Employment Application (Page 2 of 2) in pdf

NAME AND LOCATION

COURSE OF STUDY

YEARS/UNITS

GRADUATE?

DATE

COLLEGE

TRADE SCHOOL

HIGH SCHOOL

Are you at least 18 years of age?_______ Person to notify in emergency ___________________________ Phone# _______________

Can you work any day of the week and any hour of the day? _______________ If not, explain _________________________________

Have you ever applied or been employed with us before? ___________ If so, when and what position? __________________________

How did you learn about this position (state name if current or former Polly’s, Inc. employee)? ________________________________

Do you speak, write or understand any language other than English? _____________If so, explain _____________________________

What relevant business machines or computer programs can you operate? _______________________________________________

Please list any training you have received that has not been stated ____________________________________________________

May we contact your present employer? ____________ If offered a job, would you be willing to consent to a drug test? ____________

Have you ever been convicted of a criminal offense? ____________ (Note: a conviction is not an automatic bar to employment. Each

case will be considered on its own merits.) If yes, state the nature of the crime(s), when and where convicted and disposition of the case.

I hereby certify that I have not withheld any information that might adversely affect my chances for employment and that the answers given

by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this

application. I understand that any omission or misstatement of material information on this application or on any document used to secure

employment may result in rejection of this application or immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Polly’s, Inc. to thoroughly investigate my references, work record, education, D.M.V. report, criminal history, consumer credit

report and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to

Polly’s, Inc. any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In

addition, I hereby release Polly’s, Inc., my former employers and all other persons, corporations,

partnerships and associations from any and all claims, demands or liabilities arising out of or in

any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my

employment, if hired, is intended to create an employment contract between me and Polly’s, Inc. In addition, I understand

and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at will at

any time, with or without, prior notice, at the option of either myself or Polly’s, Inc., and that no promises or representations

contrary to the foregoing are binding on Polly’s, Inc. unless made in writing and signed by me and Polly’s, Inc.’s designated

representative. I agree that this constitutes an integrated agreement with respect to the at-will nature of my employment

relationship, that it is final and fully binding, and that their are no oral or collateral agreements regarding this issue.

SIGNATURE __________________________________ DATE __________

THANK YOU FOR CHOOSING

POLLY

INC

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Form APP-HR (Rev. 03/11)

Form App-Hr - Kfc Employment Application Page 2