Chick Fil A

Application

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Fields marked with * are required.

Please Tell Us About Yourself * Last Middle I. * First

Address City St: Zip

* Home Telephone Cell/Other Telephone (if applicable)

Email Address

Do you have a reliable means of transportation to work? Yes No What wage are you expecting?

If you are younger than 18 years old, how old are you?

* Are you eligible to work in the U.S.? Yes No (Proof of Eligibility Required Upon Employment)

* Have you ever been convicted of a felony? Yes No

Availability

	MON	TUE	WED	THU	FRI	SAT	Summer	School Year	All Year
FROM							Minimum number of hours needed to work
TO							Maximum number of hours needed to work

Previous Employment History

Please list your three most recent jobs (including babysitting, lawn care or volunteer work)

Have you ever worked for Chick-fil-A, Inc. or a Chick-fil-A Franchisee? Yes No

If YES, which Unit?

Name & Address of Employer

Employed From Employed To

Phone # Supervisor

Earnings Reason for Leaving

Name & Address of Employer

Employed From Employed To

Phone # Supervisor

Earnings Reason for Leaving

Name & Address of Employer

Employed From Employed To

Phone # Supervisor

Earnings Reason for Leaving

Relevant Skills

Education High School(Last attended) Location

Did you Graduate? Yes No

College & Vocational Schools Location

Did you Graduate? Yes No

Degree & Major Grade Pt. Average

College & Vocational Schools Location

Did you Graduate? Yes No

Degree & Major Grade Pt. Average

Personal Background Please list awards and/or leadership positions held (work or school)

Military Service Yes No Branch Rank

Start Date End Date

Please describe your duties

References

Please provide four references (For example, current or past employers or supervisors; teachers; other familiar with your qualifications).

* Name * Address

* Phone * Relationship * Years Known

Name Address

Phone Relationship Years Known

Name Address

Phone Relationship Years Known

Name Address

Phone Relationship Years Known

Please Read the Following Statements Carefully

I understand that I am applying for employment at this particular Chick-fil-A restaurant location only and that I am applying to work for this independent franchised Operator. I further understand that completion of this application does not indicate that there are any positions currently open and does not obligate the Operator to whom I am submitting this application to hire me.

I certify that all of the answers given in this application are true and complete to the best of my knowledge and that I have personally completed this application. I understand that providing false or misleading information or omitting pertinent information in my application or a job interview shall be grounds for rejection or this application or for immediate discharge if I am employed.

I understand that if I am employed, my employment will be for no definite period of time. I understand that my employment may be terminated at-will with or without cause, and with or without notice, at the option of either this franchised Chick-fil-A Operator or me.

I authorize all persons or businesses contacted by or on behalf of the Chick-fil-A Operator about me or my application to disclose any and all performance reviews, reports, and other documents and information related to my background, work history and qualifications, without giving me prior notice of such disclosure. I also authorize the persons named herein as references and others of whom the Chick-fil-A Operator may inquire about my background to provide the Chick-fil-A Operator with any pertinent information they may have regarding me. By signing below, I fully release the Chick-fil-A Operator, my former employers and all other persons, and businesses from any and all claims, demands or liabilities arising out of or in any way related to such references or disclosures.

* Date * Signature
(MM/DD/YYYY)

By submitting this form, you confirm that you have read and that you agree to the statements above.

1840 North Dixie HWY | Elizabethtown, KY 42701

270.982.1350 | www.chick-fil-a.com

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