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Jobs and Employment
Ball & Chain - Employment Application
WE ARE PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER
First Name
*
Last Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
*
Date of Birth
*
MM slash DD slash YYYY
Social Security Number (last 4 digits)
*
Emergency Contact
*
Emergency Contact Phone
*
Relationship
*
Marital Status
*
Single
Married
Divorced
Work Authorization
*
Select One
Authorized to work in the US
Require Sponsorship
Other
Please Explain
Name of any relatives currently employed by the company
Referred by
Employment Type
*
Open
Full Time
Part Time
Temporary
Position Desired
*
Any
Barback
Bartender
Cleaner
Cook
Dancer
Dishwasher
Food Runner / Busser
Host / Hostess
Manager
Server
Rate of pay desired
*
Please attach your resume
Max. file size: 5 MB.
WORK INFORMATION
Have you ever worked for this company before?
Check box for "YES"
Are you currently employed?
Check box for "YES"
How long have you been unemployed?
Physical History
List any physical limitations
Have you ever been injured on the job?
*
Yes
No
Please list the nature of the injury(s)
*
How much time have you lost from work in the past year from illness?
Have you ever received worker's compensation?
*
Yes
No
Workers comp start date:
*
MM slash DD slash YYYY
Workers comp end date:
*
MM slash DD slash YYYY
MILITARY STATUS
Have you ever been in the U.S. Armed Forces?
*
Yes
No
Military Branch
*
Select One
Army
Navy
Air Force
Marines
Coast Guard
Rank at time of discharge
*
Date of Discharge
*
MM slash DD slash YYYY
Education
Education Level
*
Select One
None
Current High School or GED Student
High School Diploma or GED
Trade or Technical School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
Other
Last School Attended
*
Have you ever been convicted of a felony?
*
Yes
No
Date of conviction
*
MM slash DD slash YYYY
Please explain
*
WORK HISTORY
Please provide your most recent work history first
Former Employer
*
Former Employer Phone
*
Position
*
Supervisor
*
Date Employed From
*
MM slash DD slash YYYY
Date Employed To
*
MM slash DD slash YYYY
Reason for leaving
*
Former Employer 2
Former Employer 2 Phone
Position
Supervisor
Date Employed From
MM slash DD slash YYYY
Date Employed To
MM slash DD slash YYYY
Reason for leaving
Certification
*
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and true to the best of my knowledge. I further certify that the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed regardless of time elapsed before discovery.
Background Check
*
I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving my prior notice to such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way to such investigation or disclosure.
Arbitration
*
I hereby agree to submit binding arbitration all disputes and claims arising out of the submission of this application. I further agree, in the event that I am hired by the company, that all disputes that cannot be resolved by informal internal resolution, which might arise out of my employment, will be submitted to binding arbitration. I agree that such arbitration shall be conducted under the rules of the American Association of Arbitration. This application contains the entire agreement between the parties with regard to dispute resolution, and there are no other agreements as to dispute resolution either oral or written.
At Will Employment
*
I understand that nothing contained in the application, or conveyed during any interview, which may be granted, or during my employment if hired, is intended to create an employment contract between the company and me. In addition I understand and agree that if I am employed my employment is for no definite or determinable period and may be terminated at any time with or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.
Misrepresentation
*
I agree and understand that any misrepresentation of information given above shall be considered an act of falsification. I agree and understand that the employment is factual. I agree and understand that if hired, I will be on a probationary period during which time I may be discharged without recourse.
Signature
*
Please type your name to the left as this represents your digital signature. By signing this you are stating that all information submitted on this form is true and accurate.
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