Job Application

Name :
   
Present address :
   
Social Security No. : Telephone :
   
How long : If under 18, please list age :
   
Position applied for : Salary desired (Be specific):
   
Days/hours available to work :  No Pref  Mon  Tue  Wed  Thu  Fri  Sat  Sun
   
How many hours can you work weekly : Can you work nights? :  Yes  No
   
Employment desired :  Full Time Only  Part Time Only  Full & part Time Only When available for work? :
   
Do you have any physical limitation in performing your shift?: Are you able to stand continues during shift time :
   
Are you able to lift 50 lbs frequently: Are you able to bend frequently :
   
Type of School Name of School Location Number of year Completed Major 7 degree
High School
College
Bus. or Trade Schoo
Professional Schoo
   
HAVE YOU EVER BEEN CONVICTED OF A CRIME? :  No  Yes
   
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed,and type(s)of rehabilitation.
HAVE YOU EVER BEEN CONVICTED OF A CRIME? :
   
Do you have a Driver's Lincese? :  No  Yes What is your means of transportation to work? :
   
Lincese Details :
   
Lincese Type :  Operator  Commercial (CDL)  Chauffeur
   
Have you had any accidents during the past three years? :
   
Have you had any moving violations during the past three years? :

Office Only

   
Typing:  Yes  No Word Processing:  Yes  No
   
10-key :  Yes  No Personal Computer :  Yes  No PC/MAC :  Yes  No
   
Other : Skill :
   
Please list two references other than relatives or previous employers.
   
1) Name : 2) Name :
Position : Position :
Company : Company :
Telephone : Telephone :
Address : Address :
   
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Military

   
HAVE YOU EVER BEEN IN THE ARMED FORCES? :  No  Yes ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? :  No  Yes
   
Specialty :
   
WorkExperience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
   



   



WorkExperience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
   
May we Contact Your Present Employer? :  No  Yes If not, who did? :
   
Did you Complete this Application Yourself :  No  Yes
      

PLEASE READ CAREFULLY APPLICATION FORM WAIVER

1
In exchange for the consideration of my job application by Lancaster Travel Plaza (hereinafter called “the Company”), I agree that:
2
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 Lancaster Travel Plaza, 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 Lancaster Travel Plaza 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 benefits.
3
I Authorize investigation of all statements contained in this application. I understand that the misrepresentation or 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 from any liability as a result of such contract
4
I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment 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.
5
I Understand that, in connection with the routine processing of your 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.
6
I further understand that my employment with the Company shall be probationary for a period of sixty (60) 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.

EMPLOYMENT INFORMATION FORM

   
Height : Weight : Brith Date :
   
Married :  No  Yes If married, how long? :
   
Full name of spouse : Occupation :
Name of company : Telephone :
   
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Name : Telephone :
Address : Relationship :
   
FOR INSURANCE PURPOSES ONLY: LIST ALL DEPENDENTS
   
Name Relationship Brith Date SSN
   
Date of Employment : Job title : Dept. :
   
Applicant’s signature acknowledging above information : Drug test confirmation number :
Name of person verifying information : Name of person authorizing Employment :
   
   
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 our business.
   
Applicant Selection Criteria Record
Name Male/Female Ethnic Code* OnLab Section/Off Lab
*ETHNIC CODES: 1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER
CANDIDATE SELECTED
Name Male/Female Ethnic Code* OnLab Section/Off Lab
SELECTION CRITERIA
REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS