Kauai TR Employment Application

Application for Employment Tortilla Republic

We are pleased that you are seeking employment with Tortilla Republic. Applicants are considered without regard to race, color, religion, sex, age, sexual orientation or national origin, or any factors prohibited by local, state or federal law. We are proud to be an Equal Opportunity Employer.
Personal Information *

First Name Middle Name Last Name
Email Address
example@example.com

Current Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Other Phone Number:

Area Code Phone Number
In case of emergency, please notify: *
Telephone number *

Area Code Phone Number
Please list all names you have used in the past: *
Have you ever been employed at our Company? *

Yes No
Date of hire:

Month Day Year
Date
How were you referred to our Company? *

Advertisement Employee Agency
Have you ever applied for employment at our Company? *

Yes No
Date

Month Day Year
Date

Employment Desired
Position: *
Date Available: *
Salary Desired: *
per *
Are you interested in: *

Temporary Full-Time Part-Time
Experience

List your last five (5) employers, starting with the most recent (go back 10 years), including military service. Attach separate sheet if necessary.
May we contact your current employer? *

Yes No
Employer Name: *
Address: *
Telephone number: *
Position: *
From: *
To: *
Reason for Leaving: *
Employer Name:
Address:
Telephone number:
Position:
From:
To:
Reason for Leaving:
Employer Name:
Address:
Telephone number:
Position:
From:
To:
Reason for Leaving:

Skills
Licenses or Certifications:
Can you perform the essential functions of this job, with or without reasonable accommodation? *

Yes No
Can you meet the attendance requirements of this job? *

Yes No
IF HIRED, I WILL PROVIDE PROOF OF MY LEGAL AUTHORIZATION TO WORK IN THE UNITED STATES *
References

Name three (3) individuals we may contact who have knowledge of your performance and work experience, preferably former supervisors:
Name: *
Company: *
Company Address:
Name: *
Company: *
Company Address:
Name: *
Company: *
Company Address:

I hereby certify that I have not knowingly 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 fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. *
I hereby authorize the Company to thoroughly investigate my references, work record, educationand other matters related to my suitability for employment and, further, I authorize the references Ihave listed to disclose to the Company all letters, reports and other information related to my workrecords, without giving me prior notice of such disclosure. In addition, I hereby release theCompany, my former employers and other persons, corporations, partnerships and associationsfrom any and all claims, demands or liabilities arising out of or in any way related to suchinvestigation or disclosure. *
I understand that nothing contained in the application, or conveyed during any interview which maybe granted, or during my employment, if hired, is intended to create an employment contractbetween the Company and me. In addition, I understand and agree that if I am employed, myemployment is at will and is for no definite or determinable period and may be terminated at anytime, with our without prior notice, or with or without cause, at the option of either myself or theCompany, and that no promises or representations contrary to the foregoing are binding on theCompany unless made in writing and signed by me and the Company's designated representative. *
I HAVE READ THE ABOVE PARAGRAPHS, UNDERSTAND THEIR IMPORTANCE ANDEFFECT UPON MY EMPLOYMENT, AND ACCEPT SAME AS CONDITIONS OF MYEMPLOYMENT WITH COMPANY.This application, when completed and signed, becomes the property of Company. *
Applicant Signature *

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Print Name *

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Application for Employment Tortilla Republic

Experience

References