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Form W-4     |    Form I-9
    
Carmine's Job Application
Contact Information
Name:
Street:
City:
State/Province:
Zip/Postal Code:
Phone:
Email:

Requested Information
Social Security No.
Are you 18 or older?
If not, age
Ever worked for Carmine's before?
If yes, dates and location

Availability
Total hours available per week i.e M from 11am to 6pm, Tr from 9am to 2pm etc.
Are you legally able to be employed in the U.S.?
How far do you live from the store?
Do you have transportation to work?
How did you hear of the job?

School Most Recently Attended
Name
Location
Phone
Teacher or counselor
Dept.
Last grade completed
Grade point average
Graduated?
Now enrolled?
Sports or activities

First most recent job (If not applicable, list U.S. Military, work performed on a voluntary basis or personal references.)
Company
Location
Phone
Job
Supervisor
Dates worked from - to i.e. Sep 2011 to Jun 2012
Salary
Reason for leaving

Second most recent job (If not applicable, list U.S. Military, work performed on a voluntary basis or personal references.)
Company
Location
Phone
Job
Supervisor
Dates worked from - to i.e. Sep 2011 to Jun 2012
Salary
Reason for leaving

Physical
Any health problems or physical disabilities which could affect your employment?
Do you now have or have you had, within the last six months, any contagious or communicable diseases, or gastro-intestinal infections, or have you ever had hepatitis or salmonella?
Explain any yes answer in detail

Convictions
During the past 10 years, have you ever been convicted of a crime excluding misdemeanors? (A conviction will not necessarily bar you from employment.)
If yes, describe in full

Digital Signature (BY ENTERING YOUR NAME YOU ARE DIGITALLY SIGNING THIS FORM AND AGREEING TO THE INFORMATION STATED BELOW.)
Date
Signature
 
   

1.  I certify that the information contained on this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with the policy of Carmine's Family Restaurant.

2.  I authorize the references listed above 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, if I become employed, I wil be free to terminate my employment at any time for any reason and Carmine's Family Restaurant retains the same rights.  No representative of Carmine's Family Restaurant has the authority to make any contrary agreement.

 

Carmine's Family Restaurant is an equal opportunity employer.  The Civil Rights Act of 1964 and Local Laws prohibit discrimination on the basis of race, color, religion, sex, or national origin.  In addition State and Local laws prohibit discrimination on basis of age with respect to individuals who are at least 40 years of age.  It is our policy to comply fully with these Acts and information requested on this application will not be used for any purpose prohibited by law.

YOUR APPLICATION WILL BE CONSIDERED ACTIVE FOR 30 DAYS - FOR CONSIDERATION AFTER THAT YOU MUST REAPPLY.

U.S. law requires  that, if hired, you must furnish your social security card and one of the following documents within 72 hours of starting work: 1) a card issued by Federal, State or local government showing your identity. 2) Driver's license or state issued I.D. with photo. 3) School I.D. card with photo. 4) Current INS Forms with employment authorization stamp. 5) U.S. Passport. 6) Voter's registration card. 7) U.S. Military card or other draft card.

*If you do not have a social security card, you may present an original or copy of a U.S. birth certificate, or Department or State Forms FS-545 or DS-1350 or INS Forms 1-327, 1-571, 1-197, 1-179.



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