(661) 695-MIXX

Personal Information

First Name
 
Last Name
 
Address
 
State
 
City
 
Zipcode
 
Email Address
 
Phone Number
 
Alternate Phone Number
Referred By

Employment Questionnaire

Full Time Part Time  
Desired Number of Hours per week?
Date You Can Start
Salary Desired
ARE YOU AT LEAST 18 YEARS OF AGE OR OLDER?
YES NO
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES? YES NO
ARE YOU CURRENTLY EMPLOYED?
YES NO
HAVE YOU EVER BEEN TERMINATED OR ASKED TO RESIGN FROM ANOTHER JOB? YES NO
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?If so
YES NO
HAVE YOU EVER WORKED FOR THIS COMPANY BEFORE?If so
YES NO
DO YOU HAVE ANY FRIENDS OR RELATIVES WORKING AT LOLO'S MIX?If so
YES NO
ARE YOU WILLING TO SUBMIT TO A BACKGROUND CHECK AND DRUG TEST AS A CONDITION OF EMPLOYMENT? YES NO
THIS JOB MAY REQUIRE STANDING FOR LONG PERIODS OF TIME, LIFTING UP TO 50 LBS, REPETITIVE HAND/ARM MOTIONS, AND THE SERVING AND HANDLING OF FOOD AND EQUIPMENT IN A SANITARY AND HEALTHY MANNER. IS THERE ANY REASON WHY YOU CANNOT PERFORM THESE ESSENTIAL JOB FUNCTIONS? YES NO
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR SUBJECTED TO A DEFERRED ADJUDICATION ON A FELONY CHARGE? YES NO

Work Availability

I HAVE FULL AVAILABILTY - I CAN WORK ANY DAY, ANY TIME
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

Education History

High School

Name of the school
Location of the school
Year you graduated

College

Name of the school
Location of the school
Year you graduated

Trade, Business or correspondence school

Name of the school
Location of the school
Year you graduated

Subjects of special Study/Research work or special Training/Skills

Employment History

(LIST BELOW LAST THREE EMPLOYERS, STARTING WITH MOST RECENT FIRST)

From

MONTH/DATE/YEAR
EMPLOYER
ADDRESS
PHONE

To

MONTH/DATE/YEAR
SALARY
POSITION
REASON OF LEAVING

From

MONTH/DATE/YEAR
EMPLOYER
ADDRESS
PHONE

To

MONTH/DATE/YEAR
SALARY
POSITION
REASON OF LEAVING

From

MONTH/DATE/YEAR
EMPLOYER
ADDRESS
PHONE

To

MONTH/DATE/YEAR
SALARY
POSITION
REASON OF LEAVING

References

FIRST REFERENCE

SECOND REFERNCE

Name
Name
Address
Address
Phone
Phone
Relationship
Relationship
Years Known
Years Known

Please read the following statements carefully and indicate your understanding and acceptance by signing below.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, any false statement, misrepresentation, or omission of facts on this application or on any supporting documents, regardless of when discovered to be false or omitted, may result in my immediate termination.


I authorize investigation of all statements contained herein and the references, schools and employers listed above to give you any information concerning my previous employment and pertinent information they may have, personal or otherwise, and release them and from any damage that may result from utilization of such information.


I also understand and agree that no representative of Lolo's Mix has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Lolo's Mix representative. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Lolo's Mix at any time without prior notice for any reason. I also understand that Lolo's Mix retains the right to demote, transfer, change job duties, and change compensation at any time. I understand that if hired, this statement is part of the employment agreement between Lolo's Mix and me, and will be binding upon me.


Lolo's Mix is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, national origin, the presence of mental, physical, or sensory disability, sexual orientation, or any other basis prohibited by federal, state or provincial law.


This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.


Lolo's Mix maintains a strict policy against the use of unlawful drugs and alcohol. All job applicants who receive offers ofemployment with the company must submit to and pass a drug screening test. All offers of employment are conditioned upon the successful completion of the testing procedure.


Date
Applicant's Signature
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