EMPLOYMENT APPLICATION

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1 EMPLOYMENT APPLICATION We consider applicants for all positions without regard to age, race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sexual orientation or sex of any person or any other legally protected status pursuant to California s Fair Employment Practices and Housing Acts, California Labor Code and other relevant federal, state and local laws. You must complete the application in its entirety to be considered for a position at Big Kahuna Yogurt. Please complete application in blue or black ink PLEASE PRINT--- Position applying for: (please circle) Sales Associate Assistant Manager Manager Other (please explain): How did you hear about us? Advertisement Friend/Relative Employment Agency Walk-in Other: Personal Information Last Name First Name Middle Address: Number Street City State Zip Code ( ) Best Time to Contact You : -- Phone Number am/pm Social Security Number Position Information Have you ever been employed with us before? If Yes, give dates: / to / Have you ever filed an application with us before? If Yes, give dates: Do any of your friends or relatives work with us? If Yes, which location? Can you present evidence of your U.S. citizenship or proof of your legal right to live and work in the USA? Yes No Date available to begin work: / / What is your desired pay rate? $ per hour

2 Are you available to work: Full Time Part Time Weekdays (Mn to Fri) Weekends (Sat-Sun) Any Please list the times you are available during the week: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday: Temporary/Seasonal Employment? Please indicate dates: Are you available for travel, if the job requires it? Depends Education Name and City/State Course of Study Years Completed Diploma/Degree High School College/ University College/ University Other (Specify) _ Employment History List below all present and past employment starting with your most recent employer (last 7 years is sufficient). Please write on back if this page does not give you enough space. You may include any job-related military service assignments and volunteer activities. Please account for all employment periods. 1. Employer Name: Phone Number: ( )_ Type of Business: Address & Street: Dates Employed: From /_ To /_ Job Title: Supervisor: City, State, Zip: Pay Rate: Starting $ /hr. Ending $ /hr Main Duties: Reason for leaving: May we contact this employer for a reference?

3 2. Employer Name: Phone Number: ( )_ Type of Business: Supervisor: Address & Street: City, State, Zip: Dates Employed: From /_ To /_ Pay Rate: Starting $ /hr. Ending $ /hr Job Title: Main Duties: Reason for leaving: May we contact this employer for a reference? 3. Employer Name: Phone Number: ( )_ Type of Business: Supervisor: Address & Street: City, State, Zip: Dates Employed: From /_ To /_ Pay Rate: Starting $ /hr. Ending $ /hr Job Title: Main Duties: Reason for leaving: May we contact this employer for a reference? Are you able to perform the essential functions of the job for that you are applying, either with or without reasonable accommodation? If no, please describe the functions that cannot be performed: (Note: We comply with the ADA rules and regulations and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions Please indicate clearly what job functions or activities that are difficult or can not be performed.) Have you ever been convicted of a criminal offense (felony or misdemeanor)? (Do not include any conviction under California Health & Safety Code Sections 11357(a) or (b), (c), 11364, or related to marijuana dated more than two years ago, or any posttrial diversion program, or any legally expunged conviction.) Are you currently awaiting trial for any criminal offense? ave you ever initiated an act of violence in your workplace? A yes answer will not necessarily disqualify you. Please explain any yes answer above fully so that individual circumstances can be considered. Use additional paper if needed. (If you rather discuss it in person, then please type Will discuss in person ) (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances and relevance of the position applied for may, however be considered.)

4 What makes you interested in a position at Big Kahuna Yogurt? Describe any specialized training, skills and extracurricular activities that would pertain to the position you are applying for: State any additional information you feel may be helpful to us in considering your application: Personal References List below three persons, not related to you, who have knowledge of your work performance within the last three years: Name Phone # Best Time To Call Relationship 1. ( ) am/pm 2. ( ) am/pm 3. ( ) am/pm Person(s) to Contact in an Emergency Name Cell Phone # Work Phone # Relationship 1. ( ) ( ) 2. ( ) ( ) 3. ( ) ( )

5 Applicant s Statement Please Read Carefully. Each Paragraph and Sign Below: 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, education and other matters related to my suitability for employment and, further, authorize the reference I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of disclosure. In addition, I hereby release Big Kahuna Yogurt and it s affiliates, 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 the company. 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 any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and Big Kahuna Yogurt designated representative. Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgment) be conducted by internal personnel employed by Big Kahuna, I am entitled to copies of any such public records obtained by Big Kahuna unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below. I waive receipt of a copy of any public record described in the paragraph above. //_ Date Applicant s Signature Revised 12/10 QNB

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