LICENSEE EMPLOYMENT APPLICATION Your application will be considered active for 60 days-to be considered for a job after that you must reapply.

First Name MI Last Name Home Phone ( _) Cell Phone ( _) ___

Address CityState Zip ______

Social Security #______Birth Date ______

Have you worked for KFCbefore? Yes/No if yes, dates/location(s) Reason for leaving ______

AVAILABILITY:

Total hours available per week ______

Are you legally able to be employed in the U.S.? Yes/No

How did you hear about this employment opportunity? ______How far do you live from restaurant? ______Do you have transportation? _

Hours Available:

From
To

Mon Tues Wed Thurs Fri Sat Sun

EMPLOYMENT HISTORY: (If not applicable, list work performed on a volunteer basis or personal references. Please attach a separate list of employers if more space is needed.)

May we contact your present employer? Yes/No

1)Company ______

Phone Number ( _ _ ) ______

Supervisor ______

Rate of Pay ______

2)Company______

Phone Number ( __ )______

Supervisor ______

Rate of Pay ______

Address / City / State __ Zip
Job
Dates Worked: From / To
Reason For Leaving / MGMT. REFERENCE CHECK DONE BY
Address / City / State __ Zip
Job
Dates Worked: From / To
Reason For Leaving / MGMT. REFERENCE CHECK DONE BY
Address / City / State __ Zip
Job
Dates Worked: From / To
Reason For Leaving / For King Neptune's Use Only / MGMT. REFERENCE CHECK DONE BY

3)Company ______

Phone Number ( __ )______

Supervisor ______

Rate of Pay ______

SCHOOL MOST RECENTLY ATTENDED:

Name ______Street Address ______

City ______State ______Zip ______Phone Number ( _ _ ) ______

Teacher or Counselor we may contact as a reference ______Dept. ______Last Grade Completed _

Grade Point Average Graduated? Yes/No Now Enrolled? Yes/No

U.S. MILITARY: Branch of Service: Date Entered ______Date of Discharge ______Highest Rank _____

Do you have service-related skills and experience applicable to civilian employment? Yes/No if yes, describe ______

GENERAL:

What other relevant experience or training have you had and what other activities are you involved in? (Exclude organizations that indicate race, religion, age, or national origin of members.) _

IMPORTANT: COMPLETE REVERSE SIDE

If hired, some of your responsibilities would include reporting to work on time, dressed neatly and cleanly, you would be helping us deliver friendly, accurate and fast service in a respectful, professional environment. We would want you to uphold and follow KFC operational, quality and food safety standards and help make every customer feel like a valued guest.

Please read the section below carefully before signing.

U.S. law requires that, if hired, you must furnish your choice of appropriate documentation establishing identityand employment eligibility, generally prior to starting work. Please consult a member of the management teamto see acopy of DHS form 1-9 for a complete list of acceptable documents.

'DURING THE PAST 5 YEARS, HAVE YOU EVER BEEN CONVICTED OF, PLED GUILTY TO OR PLED NO CONTEST TO A CRIME, EXCLUDING MISDEMEANORS AND TRAFFIC VIOLATIONS? Yes_ No _

IF YES, DESCRIBE IN FULL, ______

'Answering yes will not necessarily bar you from employment. Applicants are not required to disclose sealed or expunged conviction records or the existence of such records. These include, for example, youthful offender records or conviction records that have been sealed or expunged by a court order.

ARE YOU OR HAVE YOU EVER BEEN A SEX OFFENDER REGISTERED WITH ANY FEDERAL, STATE OR LOCAL GOVERNMENT AGENCY, INCLUDING ANY LISTING ON A PUBLIC WEBSITE? Yes _ No _

1. I certify that I have read this application and the information on it is complete and correct. I understand that any omissions or misrepresentation of information is grounds for dismissal.

2.I authorize the persons, employers, schools and organizations listed on this application to give you any information concerning my employment and other pertinent information they may have, personal and otherwise, and release all parties from all liability and damages that may result from furnishing this to you.

3.I acknowledge that I am applying for employment with an independently owned and operated KFC franchise, a separate company and employer from KFC Corporation and any of its subsidiaries.

4.I acknowledge that the owner of this KFC franchise reserves the right to amend or modify any of its handbooks or policies at any time and without prior notice. These policies do not create any promises or contractual rights between this employer and its employees. At this independently owned and operated KFCfranchise, employment is at will. This means an employee is free to terminate his/her employment at any time, without any reason, with or without cause, and the franchise owner retains these same rights. The owner of this independently owned and operated KFC franchise is the only person who may make an exception to this, and any exception must be in writing, addressed to a particular individual, and signed by the owner.

5.This independent KFCfranchise is an equal Opportunity Employer. Various federal, state, and local lows prohibit discrimination on account of race, color, religion, sex, age, notional origin, disability or veterans’status, or other categories protected by law. It is this KFCfranchise policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law.

6.I understand that as a part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation, personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the nameand address of the reporting agency that supplies the information.

Signature:

Date:

Hire Date:

Emp. #:

Pay Rate: