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Application for Employment

Step 1 of 2

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*** YOUR APPLICATION WILL BE ACTIVE FOR 30 DAYS. IF YOU ARE NOT HIRED DURING THAT TIME PERIOD BUT WISH TO CONTINUE TO BE CONSIDERED FOR AVAILABLE POSITIONS, YOU MUST COMPLETE A NEW APPLICATION. ***
THE COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER AND BELIEVES STRONGLY IN THE PRINCIPLES OF NON-DISCRIMINATION; THEREFORE, NO ACTION WILL BE TAKEN OR WITHHELD ON THE BASIS OF RACE, COLOR, RELIGION, SEX, DISABILITY, NATIONAL ORIGIN, AGE (40 OR OLDER), GENETIC INFORMATION, VETERAN’S STATUS, MARITAL STATUS, OR ANY OTHER LEGALLY RECOGNIZED PROTECTED BASIS UNDER FEDERAL, STATE, OR LOCAL LAWS, REGULATIONS, OR ORDINANCES.
APPLICANTS WITH DISABILITIES MAY BE ENTITLED TO REASONABLE ACCOMMODATION UNDER THE TERMS OF THE AMERICANS WITH DISABILITIES ACT, NEBRASKA FAIR EMPLOYMENT PRACTICE ACT AND LOCAL LAWS. A REASONABLE ACCOMMODATION IS A CHANGE IN THE WAY THINGS ARE NORMALLY DONE WHICH WILL ENSURE AN EQUAL EMPLOYMENT OPPORTUNITY WITHOUT IMPOSING UNDUE HARDSHIP ON THE COMPANY. PLEASE INFORM THE COMPANY’S REPRESENTATIVE IF YOU NEED ASSISTANCE COMPLETING ANY FORMS OR TO OTHERWISE PARTICIPATE IN THE APPLICATION PROCESS.
APPLICANT INFORMATION
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email
JOB INTEREST
TYPE OF POSITION DESIRED – (CHECK ALL APPLICABLE)
Check preference:*
- Salaried
- Variable Hourly
RESTAURANT OPERATIONS*
- Kitchen
- Dining Room
- Supervisor
- Management
- Other
Specify "Other" if possible
Specific Position Desired:
Location Desired (city)*
- Lincoln, NE
- Omaha, NE
Lincoln location you're applying to:*
Please select your desired location, as applications are sent directly to the stores.
- 17th and South
- 27th and Superior
- 15th and Pine Lake
- 33rd and A
- 35th and Holdrege
- 48th and Hwy 2
- 64th and Havelock
- 70th and Van Dorn Buffet
- 70th and Vine
- Premier Catering
- Haymarket Park
- UNL Student Union
- West O
Omaha location you're applying to:*
Please select your desired location, as applications are sent directly to the stores.
- 51st and Leavenworth
- 72nd and Giles
- 102nd and Maple
- 132nd and West Center
- 138th and P
- Premier Catering
Date available:
MM slash DD slash YYYY
HOURS AND DAYS AVAILABLE
ARE YOU WILLING TO WORK WEEKENDS IF YOUR POSITION REQUIRES IT?
- Yes
- No
GENERAL INFORMATION
The Fair Labor Standards Act requires that employees be at least 18 years old to work in jobs declared hazardous by the Secretary of Labor. In addition, employees serving or selling alcoholic beverages in Nebraska must be at least 19 years of age. The Fair Labor Standards Act requires the Company to maintain certain records including your birthdate, if you are younger than 19 years of age. Therefore, we ask that you fill in your birthdate if you are younger than 19 years of age.
BIRTHDATE [IF UNDER 19 YEARS OF AGE]
Month
Day
Year
ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES?*
- Yes
- No
WORK PERMIT NUMBER
EXPIRATION DATE
AFTER EXAMINATION OF THE JOB DESCRIPTION GIVEN TO YOU, CAN YOU PERFORM THE SPECIFIED JOB FUNCTIONS DESCRIBED?*
- Yes
- No
IF NO, WOULD YOU NEED A SPECIFIC ACCOMMODATION IF HIRED? PLEASE EXPLAIN:
HAVE YOU PREVIOUSLY BEEN EMPLOYED WITH THIS COMPANY OR ANY OF ITS AFFILIATES?*
- Yes
- No
If yes, when? Please include Location & Job Title.
WAS EMPLOYMENT UNDER DIFFERENT NAME?
- Yes
- No
If yes, give name:
Reason for leaving:
HAVE YOU PREVIOUSLY APPLIED FOR A POSITION WITH THIS COMPANY OR ANY OF ITS AFFILIATES?*
- Yes
- No
IF YES, GIVE DATE(S):
A CONVICTION RECORD IS NOT AN AUTOMATIC BAR TO EMPLOYMENT. EACH CASE WILL BE CONSIDERED WITH REGARD TO FACTORS SUCH AS AGE AT TIME OF OFFENSE, SERIOUSNESS, NATURE OF THE VIOLATION, AND REHABILITATION.
YOU ARE NOT REQUIRED TO DISCLOSE A SEALED JUVENILE RECORD, WHICH INCLUDES RECORDS OF: AN ARREST, BEING TAKEN INTO CUSTODY, A COMPLAINT, DISPOSITION OF A CASE, DIVERSION OR ADJUDICATION OF A CRIMINAL CHARGE, OR A SENTENCE FOLLOWING CONVICTION.
HAVE YOU EVER BEEN CONVICTED OF A VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION?*
- Yes
- No
If yes, please explain:

Employment History
(Starting with the most recent)
Employer #1
Company Name:
Phone:
Address:
Street Address City State ZIP Code
Immediate Supervisor:
Job Title:
Starting Pay Rate:
Ending Pay Rate:
Responsibilities and Duties:
Employment Dates (Month/Year):
Start
MM slash DD slash YYYY
End
End
MM slash DD slash YYYY
Reason for Leaving:
Would you like to add a second employer?*
- Yes
- No
Employer #2
Company Name:
Phone:
Address:
Street Address City State ZIP Code
Immediate Supervisor:
Job Title:
Starting Pay Rate:
Ending Pay Rate:
Responsibilities and Duties:
Employment Dates (Month/Year):
Start
MM slash DD slash YYYY
End
End
MM slash DD slash YYYY
Reason for Leaving:
Would you like to add a third employer?*
- Yes
- No
Employer #3
Company Name:
Phone:
Address:
Street Address City State ZIP Code
Immediate Supervisor:
Job Title:
Starting Pay Rate:
Ending Pay Rate:
Responsibilities and Duties:
Employment Dates (Month/Year):
Start
MM slash DD slash YYYY
End
End
MM slash DD slash YYYY
Reason for Leaving:
References
LIST INDIVIDUALS WHO ARE WELL-ACQUAINTED WITH YOUR QUALIFICATIONS. DO NOT LIST RELATIVES, FORMER EMPOYEES OR SUPERVISORS.
Name Title Address Phone Number

Use the + icon to the right to add a new row. You can add up to four references.
Applicant Statement
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE, TO THE BEST OF MY KNOWLEDGE. AND I UNDERSTAND THAT ANY MISREPRESENTATION OR WILLFUL OMISSION OF FACTS IS SUFFICIENT REASON FOR REJECTION OF MY APPLICATION OR TERMINATION OF MY EMPLOYMENT.
I HEREBY AGREE AND AUTHORIZE THE COMPANY TO DEDUCT, WITHHOLD, OR DIVERT FROM MY WAGES ANY AMOUNTS NECESSARY TO OFFSET ANY DAMAGES CAUSED BY ME OR THE VALUE OF ANY PROPERTY OR MONEY ENTRUSTED TO ME BY OR OWED BY ME TO THE COMPANY DURING THE COURSE OF MY EMPLOYMENT WITH THE COMPANY, PROVIDED THAT IT DOES NOT CAUSE ME TO RECEIVE LESS THAN THE MINIMUM HOURLY WAGE REQUIRED BY STATE AND FEDERAL LAWS.
I AGREE THAT I WILL SETTLE ANY AND ALL PREVIOUSLY UNASSERTED CLAIMS, DISPUTES, OR CONTROVERSIES ARISING OUT OF OR RELATING TO MY APPLICATION FOR CANDIDACY FOR EMPLOYMENT, EMPLOYMENT, AND/OR CESSATION OF EMPLOYMENT WITH THE COMPANY BY FINAL AND BINDING ARBITRATION BEFORE A NEUTRAL ARBITRATOR. BY WAY OF EXAMPLE ONLY, SUCH CLAIMS INCLUDE CLAIMS UNDER FEDERAL, STATE, AND LOCAL STATUTORY OR COMMON LAW, SUCH AS AGE DISCRIMINATION IN EMPLOYMENT ACT, TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED, INCLUDING THE AMENDMENTS OF THE CIVIL RIGHTS ACT OF 1991, THE AMERICANS WITH DISABILITIES ACT, THE LAW OF CONTRACT, AND THE LAW OF TORT.
I HEREBY CERTIFY THAT, IF EMPLOYED, I WILL REPORT TO MY SUPERVISOR OR OTHER MEMBER OF MANAGEMENT, IF I AM EVER HARASSED BY SOMEONE IN THE COMPANY OR IF I EVER BECOME AWARE OF ANY UNETHICAL BEHAVIOR BY ANY EMPLOYEE.
I EXPRESSLY UNDERSTAND AND AGREE THAT, IF EMPLOYED, MY EMPLOYMENT, HAVING NO SPECIFIED TERM, IS BASED UPON MUTUAL CONSENT AND MAY BE TERMINATED AT WILL, WITH OR WITHOUT CAUSE, BY EITHER PARTY (COMPANY OR ME) WITHOUT PRIOR NOTICE TO THE OTHER. I UNDERSTAND THAT IF I WANT TO LEAVE IN GOOD STANDING, I WILL PROVIDE TWO WEEKS’ NOTICE TO MY SUPERVISOR BEFORE TERMINATING MY EMPLOYMENT.
MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.
Consent to provide employment history to prospective employer
Authorized by LB 959 – Legislative Bill 959 download
I hereby give consent to any and all of my prior employers to provide information with regard to my employment with my prior employers to the Company (prospective employer).

I consent to the disclosure of the following information about me by any and all of my prior employers:
1. Date and duration of employment;
2. Pay rate and wage history on the date of receipt of this written consent;
3. Job description and duties;
4. The most recent written performance evaluation prepared prior to the date of the request for information and provided to me during the course of my employment;
5. Attendance information;
6. Results of drug or alcohol tests administered within one year prior to the request for information;
7. Threats of violence, harassing acts, or threatening behavior related to the workplace or directed at another employee;
8. Whether I was voluntarily or involuntarily separated from employment and the reasons for the separation; and
9. Whether I am eligible for rehire.
The consent is valid for six months from the date of my signature below.
Signature of Applicant:
Date*
MM slash DD slash YYYY

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