APPLICATION FOR EMPLOYMENT
Equal Opportunity Employer
Thank you for your interest in joining our team. Energetic employees are key contributors to the exceptional service we provide our guests. We do not discriminate on the basis of race, religion, veteran status, color, sex, age, national origin, disability, or any other protected class. If you are team-oriented and customer-focused, then Gumby’s, Geno’sor an affiliated company is the right place for you!
EMPLOYMENT OPPORTUNITIES—indicate your preference:
Company: Position:
Gumby’s Other(list below) Cashier Other Position(list below)
Geno’s ______Manager ______
Last Name / First Name / M.I.Primary Email Address (optional):
Address:
City: / State: / Zip:
Phone Number: Cell Phone Number (optional):
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Can you, at the time of employment, submit verification of your legal right to work in the U.S?
YES
NO
Federal law prohibits discrimination in employment because of age.
Are you 18 or older? If NO, give age:______
YES
NO
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If driving is an essential function of the job, do you have a valid driver’s license?
YES
NO
If YES, please list license number:______State____
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Have you ever been terminated from a previous employer or asked to leave? Yes No IfYES, please explain:______
TELL US ABOUT YOUR AVAILABILITY
Your desired hours of availability may impact your schedule. Certain positionsand store locations requireflexibility in hours worked.
Willing to work Holidays? Yes NoWilling to work Weekends? Yes No
FROM:
TO:
How did you hear about Gumby’s / Geno’s? ______
Have you ever been employed by Gumby’s, Geno’sand/or any affiliated company? Yes No
If YES, please indicate when ______and where______
During the past 7 years, have you been convicted of or pled guilty to a crime, excluding misdemeanors and traffic violations?
YES NO If YES, describe in full: (A conviction will not necessarily bar you from employment.)______
West Virginia Lottery Regulations (sections 29-22B-702 and 29-22B-1602) require those working with or around video lottery machines to be age 21. This will be considered for store location employment which has lottery machines. Are you age 21 or older as of the completion date of this employment application? Yes NO
EDUCATION / Name of School, City, State / Major / Number of Years Completed / Grade AverageHigh School
Vocational or Business School
College or University
Certifications
REFERENCES– Provide three we may contact / Title (i.e., Supervisor, Director, etc.) / Please explain how you know this reference:
co-worker, family member, friend, teacher, etc. / Contact Phone Number(s) – list more than one if needed / E-mail Address – list more than one if needed
EMPLOYMENT HISTORY
Instructions: Beginning with the last or present employer, list the three most recent employers for whom you have worked, whether full-time or part-time. May we contact your current and/or previous supervisors? YES NO
Date Employed FROM (Mo/Yr) / Company NameDate Employed TO (Mo/Yr) / Supervisor’s Name/Title
Last Rate of Pay / Phone Number of Employer
Hrs. per Week / Position / Description of Position
Reason for Leaving
To the best of your knowledge, would this employer rehire you? / YES / NO
Date Employed FROM (Mo/Yr) / Company Name
Date Employed TO (Mo/Yr) / Supervisor’s Name/Title
Last Rate of Pay / Phone Number of Employer
Hrs. per Week / Position / Description of Position
Reason for Leaving
To the best of your knowledge, would this employer rehire you? / YES / NO
Date Employed FROM (Mo/Yr) / Company Name
Date Employed TO (Mo/Yr) / Supervisor’s Name/Title
Last Rate of Pay / Phone Number of Employer
Hrs. per Week / Position / Description of Position
Reason for Leaving
To the best of your knowledge, would this employer rehire you? / YES / NO
EMPLOYMENT APPLICATION DISCLOSURE, ACKNOWLEDGEMENT, AND CONSENT
I understand and acknowledge that I am applying for a position with Gumby’s, Geno’s and/or an affiliated company, also referred to and represented by the term “Company.” If I am employed, I agree that my employment with the Company is at the will of the Company, which means that I can choose to leave the company at any time and the Company has the right to discharge me for any reason or no reason, with or without notice. I also understand that I may be terminated or laid off at the discretion of the Company. I expressly agree and understand that my employment is “at will” with regard to discharge, termination, and/or layoff, and it may only be changed in writing, signed by the President of the Company. I agree to abide by and conform to the Company’s rules, policies, and procedures and future conditions of employment that the Company may adopt at its sole discretion.
I affirm that all information on this application is true and complete and also understand that false information, intentional deception, and/or any omission of data will result in disqualification of employment consideration or dismissal, if employed. In connection with my application for employment, I also understand that as a condition to obtaining employment at the Company, I must successfully complete any and all necessary post offer, pre-employment checks and screens as may be applicable for the position(s) for which I am applying, such as, but not limited to, drug screen, physical, credit check, criminal background check, reference checks, driver’s license checks, etc.).
Therefore, in connection with my application for employment, I hereby authorize and indemnify, any education institution, past or present employer, law enforcement agency, or any person who has knowledge of my education, work experience, and/or criminal conviction record to release this information to the Company’s agents or designated representatives. I hereby release all persons and companies/organizations from any and all liability as a result of them providing true and accurate information.
READ CAREFULLY BEFORE SIGNING: By signing this agreement, I am confirming that I have read and understand this entire employment application and this acknowledgement disclosure, while also affirming that I am fully able and competent to complete it.
I have either read and/or a company representative has explained to me the job requirements for the specific position for which I am applying and I acknowledge that that I can perform all essential job dutiesand other duties/responsibilities described.
Applicant’s Signature:Date:
Revised: 4-2014, 1-2015
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