application for employment
APPLICATION FOR EMPLOYMENT
APPLICANT MAY BE TESTED FOR ILLEGAL DRUG
LEE’S SANDWICHES CUPERTINO
20363 STEVEN CREEK BLVD, CUPERTINO, CA 95014
TEL (408) 446-5030
FAX (408) 446-5040
EMAIL [email protected]
PERSONAL INFORMATION
Social Security Number
Name (last, first and middle)
Date of Application
Present Address
Street / Apt. No.
City
State
Zip Code
Phone Number
Permanent Address
(if different)
Street / Apt. No.
City
State
Zip Code
Cell Phone Number
Are you 18 years of age or older?
Yes
No
If hired, can you provide proof that you are allowed to work in the U.S.?
In case of emergency, contact name
Phone Number
Date you can start
Please indicate days and hours that you are
available to work
Monday
Have you ever worked for Lee’s Sandwiches before?
Where?
Salary desired
Tuesday
Yes
No
When?
Available to work
Full time
Wednesday
Exact reason(s) for leaving
Descriptions of work
Exact reason(s) for leaving
Descriptions of work
Exact reason(s) for leaving
Part time
Thursday
Friday
Saturday
Are you employed now?
Yes
No
If so, may we inquire of your present employer?
Sunday
Yes
No
Name of last supervisor at our Company
EMPLOYMENT HISTORY – List former employers, starting with the most recent.
Descriptions of work
Location / City
Who referred you to our Company?
Exact reason(s) for leaving
Name and address of employer
Phone Number
No
Relationship
EMPLOYMENT DESIRED
Position
Yes
Starting
Month/year
Leaving
Month/year
Starting
salary
Final
Salary
Attach additional sheet if necessary.
Job title
Name/title of immediate supervisor.
May we contact?
EDUCATION
High School
Location
No. of years attended
Did you graduate?
Yes
No
Major/minor studied
College
Location
No. of years attended
Did you graduate?
Yes
No
Major/minor studied
Graduate School
Location
No. of years attended
Did you graduate?
Yes
No
Major/minor studied
Trade or Technical School
Location
No. of years attended
Did you graduate?
Yes
No
Major/minor studied
PERFORMANCE OF JOB-RELATED FUNCTIONS
Are you able to perform the essential functions of the job for which you are applying with or without accommodation?
Yes
No
CRIMINAL HISTORY – A conviction (felonies or misdemeanors) will not necessarily disqualify an applicant.
Have you ever been convicted of a criminal offense (felony or
Yes
No
misdemeanor)?
If Yes, please explain
REFERENCES – Please give names of three persons not related to you whom you have known at least one year.
Name
Address
Phone
Years Acquainted
AUTHORIZATION – Please read carefully before signing the application
By signing the application, I understand that any false information or significant omissions will disqualify me from further
consideration for employment, and will be a justification for my dismissal from employment, if discovered at a later day. I give
permission for a pre-employment drug screening exam and a complete employment background check.
I also understand and acknowledge that my employment will be at-will, and may be terminated with or without cause, and with or
without notice, at any time at the option of myself or the Company.
Lee’s Sandwiches is an equal employment opportunity employer.
_________________________________________________________________
Signature of Applicant
Date
FOR OFFICE USE ONLY
Interviewed by / Title
Date
Hired?
Yes
No
Remarks
Hire Date
Shift
Start Date
Day
Work Schedule
Night
Mon
Position
Full time
Tue
Pay rate
Part time
Wed
Hours/week
Thu
Loc./Store
Fri
Sat
Sun
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