GOBI GRILLE - APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment
on any basis protected by law including race, color, age, sex, religion, disability or national origin.

PERSONAL INFORMATION

Name

*First:

Middle Initial:

*Last:

Present Address

Street:

City:

State:

Zip:

Permanent Address

Street:

City:

State:

Zip:

*Phone:		Email:
Referred By:		Are you over 18?	Yes No

EMPLOYMENT DESIRED

Position:

Start Date:

Salary Desired:

Are You Employed Now?	Yes No
If So May We Inquire of your Present Employer?	Yes No
Ever Applied to this Company Before?	Yes No
Where? When?

Availability?

EDUCATION

Grammar School

Name of School:		Location of School:
Did You Graduate?	Yes No

High School

Name of School:		Location of School:
Last Year Completed:	1 2 3 4
Did You Graduate?	Yes No

College

Name of School:		Location of School:
Last Year Completed:	1 2 3 4
Did You Graduate?	Yes No
Subjects Studied & Degree(s) Received:

Trade, Business or Correspondence School

Name of School:		Location of School:
Last Year Completed:	1 2 3 4
Did You Graduate?	Yes No
Subjects Studied & Degree(s) Received:

GENERAL

Subjects of Special Study or Research Work:

Job Related Skills (typing, driver's license, etc.):

Activities Other Than Religious (Civic, Athletic, etc):

FORMER EMPLOYERS

List below your last four employers, starting with the last one first.

Name of Employer:		Address of Employer:
Employed:	From: To:
Salary:		Position:
Reason for Leaving:

Name of Employer:		Address of Employer:
Employed:	From: To:
Salary:		Position:
Reason for Leaving:

Name of Employer:		Address of Employer:
Employed:	From: To:
Salary:		Position:
Reason for Leaving:

Name of Employer:		Address of Employer:
Employed:	From: To:
Salary:		Position:
Reason for Leaving:

REFERENCES

List below three persons not related to you, whom you have know at least one year.

Name:		Address:
Position:		Years Acquainted:
May we contact? Yes No

Name:		Address:
Position:		Years Acquainted:
May we contact? Yes No

Name:		Address:
Position:		Years Acquainted:
May we contact? Yes No

Name:		Address:
Position:		Years Acquainted:
May we contact? Yes No

Names of friends or relatives working for GOBI GRILLE:

Any Foreign Languages?

Present membership in National Guard or Reserves?	Active Inactive None

AUTHORIZATION TO CONDUCT BACKGROUND INVESTIGATION

I HEREBY ACKNOWLEDGE THAT I HAVE APPLIED FOR EMPLOYMENT, OR AM BEING CONSIDERED FOR EMPLOYMENT OR PROMOTION WITH GOBI GRILLE. I HEREBY AUTHORIZE GOBI GRILLE TO CONDUCT A BACKGROUND INVESTIGATION ON ME DURING MY CONSIDERATION FOR EMPLOYMENT OR PROMOTION. I HEREBY RELEASE ALL PARTIES PROVIDING INFORMATION TO GOBI GRILLE FROM ALL LIABILITY FOR ANY SUCH EMPLOYMENT DISCLOSURE. I ALSO AUTHORIZE GOBI GRILLE TO USE ANY INFORMATION SERVICE, WHICH IT MAY SELECT TO GATHER REPORTS AND OTHER EMPLOYEE INFORMATION INCLUDING TRANSUNION, CBI, TRW, AND ANY AUTHORIZED AGENTS OR OTHER SOURCES WHICH MAY HAVE INFORMATION CONCERNING ME, INCLUDING ALL LOCAL, CITY, COUNTY, STATE AND/OR FEDERAL AGENCIES. I UNDERSTAND THAT THE FINAL DECISION TO OFFER ME EMPLOYMENT, CONTINUE MY EMPLOYMENT, OR TO PROMOTE ME MAY BE DETERMINED, IN WHOLE OR IN PART FROM SUCH REPORTS AND INFORMATION. I HEREBY AUTHORIZE THE COMPANY (AND RELEASE FROM LIABILITY ANYONE PROVIDING IT TO THE COMPANY) TO OBTAIN ANY INQUIRIES AND REPORTS NOW AND AT ANY TIME IN THE FUTURE WHICH IT MAY CONSIDER USEFUL, RELATING TO MY CONSUMER CREDIT, DRIVING, HISTORY, MOTOR VEHICLE RECORDS AND ANY CRIMINAL CONVICTION HISTORY. ALL INFORMATION OBTAINED BY GOBI GRILLE WILL BE HELD IN CONFIDENCE FOR ITS USE ONLY.

I AM AWARE THAT CERTAIN TYPES OF CRIMINAL CONVICTIONS ALSO PRECLUDE NEW OR CONTINUED EMPLOYMENT WITH GOBI GRILLE. I HEREBY AFFIRM THAT ALL STATEMENTS AND REFERENCES I HAVE GIVEN IN CONNECTION WITH MY APPLICATION FOR EMPLOYMENT WITH GOBI GRILLE ARE TRUE; AND, IF IT IS LATER DISCOVERED, THAT I HAVE MADE ANY FALSE STATEMENT OR OMITTED ANY PERTINENT INFORMATION, THAT GOBI GRILLE WILL IMMEDIATELY TERMINATE MY EMPLOYMENT. I ALSO HEREBY VOLUNTARILY CONSENT TO DRUG TESTING PRIOR TO OR DURING MY EMPLOYMENT UPON GOBI GRILLE REQUEST. I ALSO AGREE THAT REFUSAL TO SUBMIT TO DRUG TESTING WILL RESULT IN MY NOT BEING OFFERED EMPLOYMENT OR IN MY TERMINATION, EXCEPT AS PROVIDED BY LAW TO THE CONTRARY.

I RECOGNIZE AND AGREE THAT THIS APPLICATION IS NOT A CONTRACT OR OFFER OF EMPLOYMENT, I FURTHER RECOGNIZE AND AGREE THAT IF I AM EMPLOYED BY GOBI GRILLE, THE COMPANY MAY TERMINATE MY EMPLOYMENT WITH OR WITHOUT NOTICE AND/OR CAUSE AT ANY TIME, AND AT THEIR WILL. I FURTHER RECOGNIZE AND AGREE IF I AM EMPLOYED BY GOBI GRILLE, I WILL BE SUBJECT TO ALL ITS RULES AND REGULATIONS TO WHICH I AGREE TO CONFORM, IF HIRED. I ACKNOWLEDGE THAT ALL BUSINESS INFORMATION I RECEIVE AS A RESULT OF ANY JOB I PERFORM FOR GOBI GRILLE, I WILL TREAT CONFIDENTIALLY AND AS THE EXCLUSIVE PROPERTY OF GOBI GRILLE. I ALSO AGREE THAT ALL COMPENSATION, BENEFITS, RULES AND REGULATIONS ARE SUBJECT TO CHANGE BY THE COMPANY AT ANY TIME, WITH OR WITHOUT NOTICE TO ME. I ALSO RECOGNIZE AND AGREE THAT IF I AM EMPLOYED BY THE COMPANY, I AGREE IN PARTIAL CONSIDERATION FOR MY EMPLOYMENT, THAT I SHALL NOT COMMENCE ANY ACTION OR OTHER LEGAL PROCEEDING RELATING TO MY EMPLOYMENT OR THE TERMINATION OF MY EMPLOYMENT, MORE THAN SIX MONTHS AFTER THE TERMINATION OF SUCH EMPLOYMENT. I AGREE TO WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY. I FURTHER RECOGNIZE THAT NOTHING IN ANY DOCUMENTS PUBLISHED BY THE COMPANY SHALL IN ANY WAY MODIFY THE ABOVE TERMS AND THAT THESE TERMS CANNOT BE MODIFIED IN ANY WAY BY ANY ORAL OR WRITTEN REPRESENTATIONS MADE BY ANYONE EMPLOYED BY THE COMPANY, EXCEPT BY A WRITTEN DOCUMENT SIGNED BY THE PRESIDENT OF GOBI GRILLE. AND MYSELF. I FURTHER UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS CONTINGENT ON PROOF OF EMPLOYMENT ELIGIBILITY UNDER THE IMMIGRATION AND NATURALIZATION ACT.

I HEREBY STATE THAT I AM FULLY QUALIFIED AND ABLE TO PERFORM THE DUTIES OF THE POSITION FOR WHICH I HAVE APPLIED FOR EMPLOYMENT. I AM NOT AWARE OF ANY ACCOMMODATION I NEED TO PERFORM MY JOB DUTIES OTHER THAN AS NOTED AT THE BOTTOM OF THIS RELEASE IN THE SPACE PROVIDED.

I HEREBY CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND AND AGREE THAT IF I AM EMPLOYED BY GOBI GRILLE, AND IT IS DETERMINED THAT I HAVE GIVEN FALSE INFORMATION ON THIS APPLICATION, I WILL BE SUBJECT TO IMMEDIATE TERMINATION.

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.