Date

Last Name First Name MI

Social Security Number Email Address

Telephone Number

Address

City State Zip

Are you eligible for employment in this country? Yes No

Are you at least 18 years old? Yes No U.S. Citizen? Yes No

Ever work for Jack Rabbit  before? YesNoIf yes, dates From To

Ever applied for employment with J. R.  before? YesNoIf yes, when?

Do you have relatives who work for J. R.? YesNoIf yes, name(s)

Do you have reliable transportation? YesNoIf not, explain

Are you willing to work:

Nights? Yes No Overtime? Yes No Weekends? Yes No
Holidays? Yes No

Desirable work schedule: Full-Time Part-Time

Position Applied for Cook Cashier Assistant Manager Store Manager Maintenance Technician Secretary QSR Location Manager Accountant/IS Other

Desired starting pay Date you can start

Referred by

Have you been released from confinement following a conviction for any criminal offense within the past 7 years? Yes No

Have you been convicted of a felony in the last 7 years? Yes No

Are you presently charged with any violations of law other than traffic violations? Yes No
If yes, please explain in full: (Such conviction or pending charge will not necessarily preclude you from employment. The nature of the crime and the relationship of the position applied for, the degree of rehabilitation and the elapsed time since the crime or release from confinement will be considered.)

SKILLS AND EQUIPMENT OPERATING ABILITIES

Please list any special education, skills, experience or equipment operating abilities (10 key calculator, cash register, typewriter, personal computer, etc.) you have which might be useful on the job for which you are applying.

EDUCATION

High School or Equivalent: Name Location

Last year completed 1 2 3 4 Did you Graduate? Yes No

College: Name Location

Last year completed 1 2 3 4 5 6 Did you Graduate? Yes No
Degree

Business or Trade School: Name Location

Last year completed 1 2 3 4 5 6 Did you Graduate? Yes No

EMPLOYMENT EXPERIENCE
List all full-time, part-time and summer employment, beginning with latest employer.

Employer 1

Employer From To

Address City State

Phone Number Job Title

Duties

Starting Salary Final Salary Reason for Leaving

Can we contact them? Yes No

Supervisor's Name, Title and Phone Number

Employer 2

Employer From To

Address City State

Phone Number Job Title

Duties

Starting Salary Final Salary Reason for Leaving

Can we contact them? Yes No

Supervisor's Name, Title and Phone Number

Employer 3

Employer From To

Address City State

Phone Number Job Title

Duties

Starting Salary Final Salary Reason for Leaving

Can we contact them? Yes No

Supervisor's Name, Title and Phone Number

Employer 4

Employer From To

Address City State

Phone Number Job Title

Duties

Starting Salary Final Salary Reason for Leaving

Can we contact them? Yes No

Supervisor's Name, Title and Phone Number

Did you complete this form yourself? Yes NoIf No, enter the name and address of the person whom completed this form.

Name Address

Important -- Read Carefully Before Submitting

In consideration of my employment, I agree to conform to the rules and regulations of Jack Rabbit Foods, Inc. and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or representative of Jack Rabbit Foods, Inc.,  has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I understand that Jack Rabbit Foods, Inc. may contact my current or former schools, references and employers to verify my employment, and I hereby release Jack Rabbit Foods, Inc., its officers, directors, employees and agents, and any individuals, corporations or organizations who provide such information, from any liability or claims for damages in relation to such contacts. I certify that the information contained in this application is correct and that I have not omitted any information. I understand that falsification or omission of information may result in immediate dismissal. I certify and declare that the foregoing is true and correct and complete.

I "Your Name" agree to all of the above as mentioned and declared.

Date

Press only ONCE. Make sure all information is correct before submitting.