EMPLOYMENT APPLICATION

Employer: One Thirty Five Prime, LLC

Address: 1201 Hewitt Drive, Ste. 110

City/State/Zip: Waco, Texas 76712

Telephone: 254-666-3100

It is the policy of One Thirty Five Prime, LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

Date *

Applicant Name *

Address

Street Address *

City *

State *

Postal Code *

Number of Years at this Address *

Daytime Phone *

Evening Phone

Email Address *

Social Security Number *

Who should be contacted if you are involved in an emergency?

Contact Name *

Relationship to You *

Address *

City *

State: *

ZIP *

Daytime Phone *

Evening Phone

Are you a citizen of the U.S.? *

If not, do you have the legal right to live and work in the U.S?

Have You Ever Been Convicted of a Felony? *

Job Position Applied For: *

Please Select

Waiter
Host
Kitchen
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List is empty.

Are you at least 18 years old? *

Please Select

Yes
No
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How Will You Get To Work? *

If you are offered employment, when would you be available to begin work? *

Have you applied with this company before? *

If yes, when?

Applicant Employment History: List your current or most recent employment first.

Employer Name

Address

City

State

ZIP

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

Employer Name

Address

City

State

ZIP

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

Applicant’s Education and Training: List your education and training.

High School Name

Diploma?

Please Select

Yes
No
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College Name

Did you receive a degree?

Please Select

Yes
No
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If Yes, degree received

Are you currently in school?

What's your Schedule?

Monday

Tuesday

Wednesday

Thursday

Friday

Applicant’s Skills: List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Skill Years of Experience Rating

Skills *

Skills Rating *

Skills *

Skills Rating *

Do you have restaurant experience? *

Do you have fine dining experience? *

Are you familiar with selling/serving wine? *

Are you TABC Certified? (if yes, please provide a copy of certificate) *

(TABC and Food Handling Certification is the sole responsibility of the employee and is a state requirement)

References: List any two people who would be willing to provide a reference for you

Reference Name *

Reference Address *

City/State/Zip *

Telephone *

Relationship *

Reference Name *

Reference Address *

City/State/Zip *

Telephone *

Relationship *

Please provide any other information that you believe should be considered: *

CERTIFICATION

I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize One Thirty Five Prime, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Company President, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of One Thirty Five Prime, LLC, except in a specific written contract of employment signed on behalf of the organization by its Company President, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Applicant Signature *

Clear

Date *