Employment Application Form Page 2
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1
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4Personal Information
NAME (First, Middle, Last)
OTHER NAME(S) YOU HAVE USED AT WORK OR SCHOOL
PHONE NUMBER
SOCIAL SECURITY NUMER (Optional)
STREET ADDRESS
CITY, STATE, ZIP CODE
HOW LONG HAVE YOU LIVED AT YOUR CURRENT ADDRESS?
PERSON TO CONTACT IN EMERGENCY (Name and Phone Number)
Are you under the age of 18?
Yes
No
If “yes,” can you, after employment, show proof of age?
Yes
No
Can you, after employment, submit certification of your legal right to work in the U.S.?
Yes
No
Have you ever been counseled or disciplined for being late or absent from work or school?
Yes
No
The U.S. Secretary of Health and Human Services has determined that certain diseases, including hepatitis A,
salmonella, shigella, staphylococcus, streptococcus, giardia, 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 serving food or
handling food equipment in a sanitary and healthy fashion. Can you, with or without reasonable accommodation, perform
this essential function of this job?
Yes
No
Have you ever been convicted of a felony, a crime involving dishonesty, or a crime involving violence to another person?*
Yes
No
If yes, please describe, including dates charged, penalties, and current disposition. Note: Convictions are not an
automatic disqualification from employment.
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
* Residents of Maryland, Massachusetts, and Washington State, read the information about this question on the back page.
Position Requested
Team Member: No experience required
Shift Lead: Food service or retail experience required
Assistant Manager/Restaurant General Manager: Management experience required
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
FROM
TO
FROM
TO
FROM
TO
FROM
TO
FROM
TO
FROM
TO
FROM
TO
Do you have reliable transportation to get to work?
Yes
No
Would you be willing to work at another Taco Bell store?
Yes
No
If hired when could you begin work? (Month/Day/Year)
How many hours would you like to work each week?
Education
NAME
CITY, STATE
# OF YEARS
GPA
DEGREE OR DIPLOMA
CONTACT PERSON
COMPLETED
DEPARTMENT/PHONE
HIGH SCHOOL
COLLEGE
OTHER
PLEASE LIST ALL JOB-RELATED ORGANIZATIONS, CLUBS, OR ACTIVITIES YOU ARE/WERE INVOLVED IN AT SCHOOL, EXCEPT THOSE THAT
INDICATE RACE, RELIGION, COLOR, NATIONAL ORIGIN, ANCESTRY, SEX, OR AGE.
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Parent category: Business