Newport / Naples Rib Company – An Equal Opportunity Employer

Application for Employment

 Pre-Employment Questionnaire
Thursday, March 11, 2010 
PERSONAL INFORMATION
Name (last, first and middle)
Present address
City
State
ZIP Code
Permanent address (if different)
City
State
ZIP Code
Email address
Phone number
Cell Phone number
Are you 18 years of age or older?
Yes     No
After employment, can you provide proof that you are allowed to work in the US?
Yes     No

EMPLOYMENT DESIRED
Location
Naples Rib Co (Long Beach)    Newport Rib Co (Costa Mesa)    Newport Rib Co @ Ladera Ranch
Position
Date you can start
Salary desired
Available to work
Full time  Part time
Are you employed now?
Yes     No
If yes, may we inquire of your present employer?
Yes     No
Who referred you to our Company?
Have you ever worked for us before?
Yes     No
If yes, where?
If yes, when?
Exact reason(s) for leaving
Name of last supervisor at our Company

FORMER EMPLOYERS - Your last four employers, starting with the most recent
Name/Address
Start
Date
Final
Date
Start
Salary
Final
Salary
Title/
Position
Description
of work
Reason for leaving   Termination:Voluntary  Involuntary
Supervisor   May we contact? Yes No     Phone #

Name/Address
Start
Date
Final
Date
Start
Salary
Final
Salary
Title/
Position
Description
of work
Reason for leaving   Termination:Voluntary  Involuntary
Supervisor   May we contact? Yes No     Phone #

Name/Address
Start
Date
Final
Date
Start
Salary
Final
Salary
Title/
Position
Description
of work
Reason for leaving   Termination:Voluntary  Involuntary
Supervisor   May we contact? Yes No     Phone #

Name/Address
Start
Date
Final
Date
Start
Salary
Final
Salary
Title/
Position
Description
of work
Reason for leaving   Termination:Voluntary  Involuntary
Supervisor   May we contact? Yes No     Phone #

EDUCATION HISTORY
 
Name & Location
# Years
Attended
Did you
graduate?
Major/Minor
Studied
High School
College
Graduate School
Trade School

MILITARY SERVICE
Describe any military service skills that may be relevant to the job you are applying for

OTHER SKILLS, QUALITIES OR CHARACTERISTICS
Describe any other skills, qualities or characteristics that you possess which would be valuable to Newport/Naples Rib Company

PERFORMANCE OF JOB-RELATED FUNCTIONS
Are you able to perform the essential functions of the job for which you are applying with or without accomodation?
Yes No

CRIMINAL HISTORY - A conviction will not necessarily disqualify an applicant
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)?*
Yes No     If yes, how many times
Explain fully each conviction (and guilty or nolo contendere plea)

REFERENCES - Three people not related to you, that you've known for at least one year
Name Address Phone Business Years Known

AUTHORIZATION
Before sending your application, please take a moment to make sure you have completed all of the questions. Failure to complete all of the questions may delay or prevent the processing of your application. By pressing the button below you are agreeing to all of the following:
I declare under penalty of perjury that the information contained in this application is true and complete to the best of my knowledge.

I understand that any false information or significant ommissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.

I agree to immediately notify the Company if I should be convicted of any crime while my job application is pending or during my period of employment, if hired.

I give permission for a pre-employment drug screening exam.

I give permission for a complete employment background check.

I consent to the appropriate release of any and all medical information, as may be deemed necessary.

I understand that, if hired, I may be required to sign a company arbitration agreement.

I understand that, if hired, I may not hold other employment unless given permission in writing by the Company.

Agreement for At-Will Employment
I understand and acknowledge that my employment will be at-will, and may be terminated with or without cause, and with or without notice, at any time at the option of myself or the Company. Only the President of the Company has the authority to enter into an employment agreement for a specified period of time or for the termination only for cause, and any such agreement must be in writing. Except to the extent I am covered by such a written agreement, I understand and acknowledge that this constitutes the entire agreement between me and the Company regarding the term of my employment and supercedes any other oral or written agreement.

Compliance With Rules
If I become employed, in consideration of my employment, I understand that I must comply with the rules, regulations, policies and procedures of the Company.

Release
I authorize the investigation of all statements contained in the Employment Application form and further authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in the Employment Application form to provide the Company with records, information, and opinion that may be useful in making a hiring decision. I release all informants from all liability for any damage that may result from furnishing information and opinion (which is truthful or made in good faith) to the Company.
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