Dear Applicant:

Welcome to KirbyG’s™! Prior to completing the application for employment, please understand that we are serious about creating a productive and enjoyable working environment for our staff and maintaining the highest levels of quality customer service for our guests. We want you to understand that we also believe in living our values, some of which are:

· We believe in working as a team

· We believe in being professional and congenial to staff and customers

· We believe in honesty and integrity.

· We believe that only a happy and professional staff can give the level of personal service we demand.

· We believe in the ongoing training and development of our staff and see it as a worthy investment in the future of the company.

· We believe in providing legendary service – the unique and powerful sort of personal care and attention that our guests tell stories about.

· We believe that everyone is capable of being an A+ player.

· We believe in learning our customer’s names and making them feel at home.

· We believe in taking care of our employees

We have high expectations of our employees, but require only what we expect of ourselves. If this feels like an environment for you, please complete this form to submit your application - note that your application will not be submitted until you click the “Submit” button at the end of this form. We look forward to reviewing your application.

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* 1. Personal Information:

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* 2. Are you at least 18 years old? If you are under 18 years of age, can you furnish a work permit?

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* 3. Are you a veteran?

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* 4. Are you legally eligible to work in the United States? Please note that if you are selected for employment, you will be required to provide appropriate documentation to verify your eligibility. Acceptable forms of proof include U.S. citizenship documentation, such as a passport or driver's license, or immigration status verification, such as a green card.

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* 5. Have you ever been discharged or asked to resign from any position?
If yes, please describe:

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* 6. Have you been convicted of a crime? If yes, state the nature of the offense (eg. felony or misdemeanor theft). and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment. Failure to report it,)

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* 7. Have you been convicted of an alcohol related serving violation, such as serving to a minor or serving someone without a valid ID? If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a record does not constitute an automatic bar to employment.)

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* 8. Which position are you applying for?

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* 9. Why are you seeking a new job at this time?

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* 10. Select the best time for you to work.

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* 11. Are you willing to work weekends and holidays?

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* 12. If you live more than an hour away, are you willing to relocate for this position?

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* 13. Are you seeking full time, part time or temporary employment?

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* 14. Enter your past education.
(School name, Start/End Date, Graduation/Graduation Date)

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* 15. List any special skills or training, such as ServSafe Training or First Aid/CPR:
(Type Training, Date of Training, Expiration Date)

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* 16. Enter your previous work history
(Company name, Start/End Date, Pay rate, Reason for leaving)

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* 17. Enter three references from past employers with their telephone numbers.

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* 18. Tell us why you would be a great candidate for KirbyG's Diner.

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* 19. What is the best time for you to interview, Monday-Thursday?

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* 20. Upload your resume (optional)

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* 21. Upload your cover letter (Optional)

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* 22. Additional links (Optional)

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* 23. How did you hear about this position?

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* 24. Certification That Application is Truthful & Complete (please read carefully, then click below)

I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired.

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* 25. Investigation Agreement (please read carefully, then click below)

I authorize this company to make an investigation of all information contained in this employment application, and I release from liability all companies and corporations supplying such information. I understand that any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge.

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* 26. Current or Previous Employment Agreement (please read carefully, then click below)

I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer.

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* 27. Credit Report Agreement (please read carefully, then click below)

I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

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* 28. Drug Testing Agreement (please read carefully, then click below)

I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician.

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* 29. AT-WILL EMPLOYMENT AGREEMENT

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only the company’s President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.

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* 30. Enter Today's Date

Date

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* 31. Please sign your application by typing your full name in the designated box.

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