1. *Name:
2. *E-mail:
3. Address:
4. City:
5. State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
6. Zip Code:
7. Phone Number:
8. Social Security Number:
9. Due to Federal, State and Local Regulations regarding the performance of certain duties, please state:
10. Are you 16 years of age or older?
Yes No

11. Are you 18 years of age or older?
Yes No

12. With in the past 7 years, have you ever been convicted of a crime or plead guilty or no contest to a crime other than a minor traffic violation?
Yes No

13. If yes, describe in full:
14. (Note: Criminal convictions are not an absolute bar to employment, and will only be considered in relation to specific job requirements).
15. Are you legally eligible to work in the U.S.A.?
Yes No
(Note: Proof of U.S. citizenship or immigration status will be required upon employment).



16. Education

    
    

    School	Name and Location	Major/Course	Degree
    High School
    College




17. US Military Experience

    
    Branch: From: To:
    Location(s):
    What Jobs Did You Hold/Duties Performed:



18. Employment

    
    

    Name, Address, and Phone Number of Employer	Position	Wage/Salary	Supervisor	From	To	Reason For Leaving	May We Contact?



19. Desired Position:
Full-Time Part-Time

20. Availability:
    Monday Tuesday Wednesday Thursday Friday Saturday Sunday


21. *Preferred Location:
2429 South 132nd Street, Omaha
2579 South 171st Court , Omaha
2085 North 120th Street, Omaha
1040 South 74th Plaza, Omaha
4303 North 72nd Street, Omaha
8406 Park Drive, Omaha
13th & Howard - Old Market, Omaha
3617 Denmark Drive - Metro Crossing, Council Bluffs
27th & Pine Lake, Lincoln
13386 Metcalf , Overland Park
947 New Hampshire, Lawrence

APPLICANT: READ ACKNOWLEDGMENT CAREFULLY
The facts set forth in this application are true and accurate to the best of my knowledge and belief.
I understand that I will not be hired to work a fixed schedule and that scheduled hours may vary from week to week depending on business needs.
I understand that any false information I record on this application or deliberate omission of any information requested will be sufficient reason for rejection of my application or termination of my employment. I further understand and agree that if my employment is terminated, I must immediately return all of the corporation's property in my custody, including office keys, uniforms and manuals. I understand that completing this application does not constitute an agreement by PepperJax Grill to employ me.
In making this application, I also understand that all information I have furnished may be investigated for verification by contacting former employers (except where otherwise indicated herein), references, and any parties or sources who may have information PepperJax Grill deems relevant to my employment, including criminal and educational records. I authorize PepperJax Grill and its representatives to conduct such and investigation and release from all liability or damage those individuals, firms, or employers who may provide any such information, and PepperJax Grill in gathering such information.
I understand that if I obtain employment with PepperJax Grill, my employment will not be for a fixed period of time and that it can be terminated by the Company, or me, with or without notice for any reason or no reason, and without liability for wages, salary or other compensation or benefits except what I have earned as of the date of termination, or specified by federal. State. Or local law. No employee or agent of PepperJax Grill, other than a Corporate Officer, has the authority to make additions, deletions, or modifications to this Acknowledgment.

WE PARTICIPATE IN E-VERIFY