APPLICATION FOR EMPLOYMENT
We are an Equal Opportunity Employer
First Name:
Middle:
Last Name:
Email:
Address:
City:
State:
  
ZIP Code:
Telephone:
 
Position Applied For:
Are you over 18 yrs of age?
    
Are you available?:
    
What days and hours are you available to work?
Mon: Tues:
Wed: Thurs:
Fri: Sat:
Sun:    
Salary desired:
If hired, date you can start:
    
 
If you require any accommodation(s) during your employment interview, please request such in advance of interview.
EDUCATIONAL BACKGROUND
 
School
City
State
Years
Completed
Degree
Other:
 
 
 
College:
 
 
 
 
High School:
 
 
 
 
Elementary:
 
 
 
 
List of courses you are currently taking:
 
Do you plan to take additional courses?
    
Which?
  
Where?
 
   
Do you possess a professional trade license certificate?
    
Type?
  
Isssued by?
  
Expires:
    
 
     
     
Have you ever been convicted of a crime?
    
(Please exclude misdemeanor convictions for marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated; and misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed.)
If Yes, briefly describe the nature of the crime(s), the date and place of conviction(s), and the legal disposition of the case(s):
 
The company will not deny employment to any applicant solely because the person has been convicted of a crime. Each case will be evaluated based on its own facts and merits.
EMPLOYMENT HISTORY
List your past employers, assignments or volunteer activities, starting with the most recent. Account for all occupied and unoccupied time during the past ten years. Attach separate sheet if necessary.
Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
     per
Final Salary:
     per 
Summarize the nature of the work performed and job responsibilities.
 

 
Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
   per
Final Salary:
   per 
Summarize the nature of the work performed and job responsibilities.
 

Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
   per
Final Salary:
   per 
Summarize the nature of the work performed and job responsibilities.
 

Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
     per
Final Salary:
     per 
Summarize the nature of the work performed and job responsibilities.
 

Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
     per
Final Salary:
     per 
Summarize the nature of the work performed and job responsibilities.
 

Employer:
  
Telephone:
   - -
Address:
  
Job Title:
  
Immediate Supervisor and Title:
  
Reason for leaving:
  
May we contact this employer?
    
Dates Employed:
   from:
 
  to:
 
Starting Salary:
     per
Final Salary:
     per 
Summarize the nature of the work performed and job responsibilities.
 
Comments (including explanation of any gaps in employment):
 
Have you ever served in the U.S. Armed Forces?
    
Branch of Service:
  
REFERENCES
List two references (not relatives or former employers) whom you have known for at least five years)
Name:
  
Work Number:
   - -
Home Number:
   - -
Name:
  
Work Number:
   - -
Home Number:
   - -
 
HEALTH
Are you able to perform the essential duties, with or without accommodation(s), of the position for which you are applying?    
 
Person to be notified in case of emergency:
Name:
  
Telephone:
   - -
Address:
  

City:

  
State:
  
ZIP Code:
  
 
PERSONAL
After employment, can you submit proof of identity and legal right to work in the United States?
    
Have you ever worked under another name?
    
If Yes, list name(s):
  
Have you ever applied for or worked for Ruby’s Diner?
    
If Yes, list when/location:
  
Do you have any friends and/or relatives who have worked for Ruby’s Diner past or present?
    
If Yes, state name(s) and relationship:
  
List any hobbies, special interests or professional organizations:
  
(You may omit those which indicate your race, religion, color, disability, marital status, national origin, ancestry, sex or age.)
 
AGREEMENT

PLEASE READ CAREFULLY BEFORE SUBMITING

I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any statements checked by Ruby’s Diner unless I have indicated to the contrary. I authorize the references listed above to provide Ruby’s Diner any and all information concerning my previous employment and any pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that my result from furnishing such information to Ruby’s Diner as well as from any use or disclosure of such information by Ruby’s Diner or any of its agents, employees or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, in my immediate dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of Ruby’s Diner, as amended from time to time in Ruby’s Diner’s sole discretion. I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at Ruby’s Diner’s option. I understand that no employee or representative of Ruby’s Diner, other than the President of the Company, has any authority to enter into any agreement for employment for any specified period of time, or to make any express or implied agreement contrary to the foregoing. Further, the President of the Company, may not alter the at-will nature of the employment relationship or enter into any employment agreement for a specified time unless the President and I both sign a written agreement that clearly and expressly specifies that intent to do so. I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or collateral agreements regarding this issue.

I also understand that all offers of employment are conditioned on the receipt of satisfactory responses to reference requests and the provision of satisfactory proof of an applicant’s identity and legal authority to work in the United States.

I further understand that the use of illegal drugs is prohibited during employment. If Ruby’s Diner requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. 

Please check and initial that you have read the above agreement, understand it, and voluntarily agree to its provisions.

 
 

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