PERSONAL INFORMATION

Name

First Name

Last Name

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent Address (If different than above.)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Are you over 18 years of age?

Yes

Are you over 21 years of age?

Yes

Are you currently authorized to work in the United States?

(If hired, verification will be required by law.)

Yes

Have you ever pled "guilty", "no contest", or been convicted of a crime?

Yes

If YES, please explain the nature of the Offense, Date and Penalty:

Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness, and nature of the violation, rehabilitation and position applied for will be considered.

EMPLOYMENT DESIRED

If you are applying for more than one position, which is your preferred job role?

Type of Employment Desired

Date You Can Start if Hired

YYYY

Are you currently employed?

Yes

If so, would you need to provide your current employer with a 'two-week notice' if hired?

Yes

How many hours can you work weekly?

Salary Desired

How did you hear about this job opportunity?

The U.S. Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, and campylobacter, may prevent you from serving good food or handling food equipment in a sanitary or healthy fashion. An essential function of this job involves serving food or handling food equipment in a sanitary and healthy fashion. Can you, with or without reasonable accommodation, perform this essential function of this job?

Yes

EDUCATION

High School

Name of High School

Location

Last Year Completed

Did you graduate?

Yes

Year of Graduation

College

Name of College/University/Trade School

Location

Last Year Completed

Did you graduate?

Yes

Year of Graduation

Major/Area of Study

Do you have any other education, training, or certifications that you believe will help you excel at the position for which you are applying?

EMPLOYMENT HISTORY

Please list past employers starting with the most recent.

1. Employer Information (Current or Most Recent Employer)

Please Include Name & Address

Telephone

(###)

###

####

Position

Job Duties

Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.

Manager

Salary

Dates of Employment

MM/YYYY of Hire - MM/YYYY of Departure

Reason for Leaving

May we contact this employer?

Yes

2. Employer Information

Please Include Name and Address

Telephone

(###)

###

####

Position

Job Duties

Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.

Manager

Salary

Dates of Employment

MM/YYYY of Hire - MM/YYYY of Departure

Reason for Leaving

May we contact this employer?

Yes

3. Employer Information

Please Include Name and Address

Telephone

(###)

###

####

Positon

Job Duties

Please list and describe any job responsibilities, skills, and/or achievements you would like us to know about as we consider your application.

Manager

Salary

Dates of Employment

MM/YYYY of Hire - MM/YYYY of Departure

Reason for Leaving

May we contact this employer

Yes

Additional Employment History

Use the space below to add any additional past employment history you may have. Please include the information listed above for each former employer.

PERSONAL & PROFESSIONAL REFERENCES

Please include a minimum of one personal reference and one professional reference not related to you.

Reference # 1

First Name

Last Name

Phone

(###)

###

####

Relationship

Years Acquainted

Reference # 2

First Name

Last Name

Phone

(###)

###

####

Relationship

Years Acquainted

Reference # 3

First Name

Last Name

Phone

(###)

###

####

Relationship

Years Acquainted

A FEW MORE QUESTIONS...

We want to get to know you a little bit better! Please answer the following questions to the best of your ability.

Tell us about a time you gave excellent customer service.

Now tell us about a time you made a customer service mistake. What did you do to fix it?

If you could describe a perfect work environment, what would it look like?

What are your career goals?

If we were to hire you for this position, how would you make an immediate impact on our organization?

APPLICATION FORM WAIVER (PLEASE READ CAREFULLY)

IN EXCHANGE FOR THE CONSIDERATION OF MY JOB APPLICATION BY BRIXENS, LLC (HEREAFTER CALLED “THE COMPANY,”) I AGREE THAT: NEITHER THE ACCEPTANCE OF THIS APPLICATION NOR THE SUBSEQUENT ENTRY INTO ANY TYPE OF EMPLOYMENT RELATIONSHIP, EITHER IN THE POSITION APPLIED FOR OR ANY OTHER POSITION, AND REGARDLESS OF THE CONTENTS OF EMPLOYEE HANDBOOKS, PERSONNEL MANUALS, BENEFIT PLANS, POLICY STATEMENTS, AND THE LIKE AS THEY MAY EXIST FROM TIME TO TIME, OR OTHER COMPANY PRACTICES, SHALL SERVE TO CREATE AN ACTUAL OR IMPLIED CONTRACT OF EMPLOYMENT, OR TO CONFER ANY RIGHT TO REMAIN AN EMPLOYEE OF BRIXENS, LLC, OR OTHERWISE TO CHANGE IN ANY RESPECT THE EMPLOYMENT-AT-WILL RELATIONSHIP BETWEEN IT AND THE UNDERSIGNED, AND THAT RELATIONSHIP CANNOT BE ALTERED EXCEPT BY A WRITTEN INSTRUMENT SIGNED BY THE PRESIDENT/GENERAL MANAGER OF THE COMPANY. BOTH THE UNDERSIGNED AND BRIXENS, LLC MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITHOUT SPECIFIED NOTICE OR REASON. IF EMPLOYED, I UNDERSTAND THAT THE COMPANY MAY UNILATERALLY CHANGE OR REVISE THEIR BENEFITS, POLICIES, AND PROCEDURES AND SUCH CHANGES MAY INCLUDE REDUCTION IN OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL AT ANY TIME WITHOUT ANY PREVIOUS NOTICE. I HEREBY GIVE THE COMPANY PERMISSION TO CONTACT SCHOOLS, PREVIOUS EMPLOYERS, (UNLESS OTHERWISE INDICATED,) REFERENCES, AND OTHERS , AND HEREBY RELEASE THE COMPANY FOR ANY LIABILITY AS A RESULT OF SUCH CONTRACT. I ALSO UNDERSTAND THAT (1) THE COMPANY HAS A DRUG AND ALCHOHOL POLICY THAT MAY PROVIDE FOR PRE-EMPLOYMENT TESTING AS WELL AS TESTING AFTER EMPLOYMENT; (2) CONSENT TO AND COMPLIANCE WITH SUCH POLICY IS A CONDITION OF MY EMPLOYMENT, AND (3) CONTINUED EMPLOYMENT IS BASED ON THE SUCCESSFUL PASSING OF TESTING UNDER SUCH POLICY. I FURTHER UNDERSTAND THAT CONTINUED EMPLOYMENT MAY BE BASED ON THE SUCCESSFUL PASSING OF JOB-RELATED PHYSICAL EXAMINATIONS. I UNDERSTAND THAT, IN CONNECTION WITH THE ROUTINE PROCESSING OF THIS EMPLOYMENT APPLICATION, THE COMPANY MAY REQUEST FROM A CONSUMER REPORTING AGENCY AN INVESTIGATIVE CONSUMER REPORT INCLUDING INFORMATION AS TO MY CREDIT RECORDS, CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS, AND MODE OF LIVING. UPON WRITTEN REQUEST FROM ME, THE COMPANY, WILL PROVIDE ME WITH ADDITIONAL INFORMATION CONCERNING THE NATURE AND SCOPE OF ANY SUCH REPORT REQUESTED BY IT, AS REQUIRED BY THE FAIR CREDIT REPORTING ACT. I FURTHER UNDERSTAND THAT MY EMPLOYMENT WITH THE COMPANY SHALL BE PROBATIONARY FOR A PERIOD OF NINETY (90) DAYS, AND FURTHER THAT AT ANY TIME DURING THE PROBATIONARY PERIOD OR THEREAFTER, MY EMPLOYMENT RELATION WITH THE COMPANY IS TERMINABLE AT WILL FOR ANY REASON BY EITHER PARTY.

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

Signature of Applicant

Enter Electronic Signature

Today's Date

YYYY

THIS COMPANY IS AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER. WE ADHERE TO A POLICY OF MAKING EMPLOYMENT DECISIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, CITIZENSHIP, AGE OR DISABILITY. WE ASSURE YOU THAT YOUR OPPORTUNITY FOR EMPLOYMENT WITH THIS COMPANY DEPENDS SOLELY ON YOUR QUALIFICATIONS.

Thank you for completing this application form and for your interest in becoming a part of the Brixens Team! If you have a resume, please email it to team@brixens.com

Join our team!