
TEXAS DE BRAZIL DOES NOT DISCRIMINATE
BASED ON RACE, COLOR, SEX, RELIGION,
NATIONAL ORIGIN, ANCESTRY, AGE,
DISABILITY, MARITAL STATUS OR ANY
OTHER BASIS AS PROTECED BY FEDERAL,
STATE OR LOCAL LAW. TEXAS DE BRAZIL IS
AN EQUAL OPPORTUNITY EMPLOYER.
A P P L I C AT I O N F O R
E M P L O Y M E N T
Fill out the application form completely. If questions are not applicable, enter “N/A”. Do not leave any question blank.
Resumes will be accepted as additional information but not in place of a completed application. Be sure to sign and date the application.
Date of application _____/_____/_____
Name ___________________________________________________________________________________________________________________________
Address
(CURRENT) _________________________________________________________________________________________________________________
Phone __________________________________________________________________________________________________________________________
Type of position desired ____________________________________________________ Can you work
Lunch Dinner Both?
Salary/Wage expected $________________________
Full Time Part Time Date available for work _______________________________
Is there any day(s) or time(s) you cannot work? _________________________________________________________________________________________
Overall Availability Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Earliest I can work
Latest I can stay
Were you previously employed by this organization?
Yes No If yes, list date(s) _____________________________________________________
Is there any reason you cannot perform, with or without reasonable accommodation, the essential functions of the position/positions for which you are applying?
Yes No If yes, explain _____________________________________________________________________________________________________
Are you legally authorized to work in the United States?
Yes No (If hired, verification will be required consistent with federal law.)
BACKGROUND INFORMATION
During the past seven years, have you ever been discharged, suspended or asked to resign from any position? Yes No
If yes, please explain _______________________________________________________________________________________________________________
For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations
you have listed?
Yes No If yes, specify name _________________________________________________________________________________
Have you ever been convicted of any crime, pleaded guilty or nolo contendere, had adjudication withheld and/or been released from confinement
following a conviction for any criminal offense?
Yes No Record
You should answer “no record” if: a conviction has been sealed, impounded or expunged or otherwise statutorily eradicated; if you were convicted of a
youthful offender adjudication, or a juvenile delinquency proceeding or adjudication, for a bail forfeiture. Applicants in Utah should answer “no record” if
they have applicant who has not been convicted of a felony. If you checked yes, please explain below. A criminal conviction will not necessarily be a bar to
employment. To help us evaluate your application, please describe the nature of the crime and your subsequent rehabilitation.
Have you ever been a defendant in a civil action alleging discrimination, harassment, fraud, defamation, assault and battery, invasion of privacy or false
imprisonment?
Yes No If yes, include the nature of the incident, your involvement, and the disposition of the case.
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
EDUCATION
(Note: transcripts may be required for verification of education)
Name & Number of Semester Type of Major Field
Type of School Location of School Hours Completed Graduated Diploma or Degree of Study
High School or G.E.D.
Yes No
College, University,
Technical or Vocational
Yes
No
Do you have a Food Handler Card?
Yes No From what city/county? ______________________________________________________________
Do you have an Alcoholic Beverage Card?
Yes No If yes, when does it expire? ______________________________________________________
Are you of legal age to serve alcohol (18 years or older, Utah state law minimum age is 21).
Yes No
Do you have reliable transportation?
Yes No If no, please explain ________________________________________________________________
Driver License number___________________________________________________ State____________________________________________________
Are you currently enrolled in school?
Yes No If yes, where and when _____________________________________________________________
OTHER LANGUAGES (Include Sign Language)
Language: ___________________ SPEAK:
Fair Good Excellent
READ:
Fair Good Excellent
WRITE:
Fair Good Excellent
SIGN:
Fair Good Excellent
Language: ___________________ SPEAK:
Fair Good Excellent
READ:
Fair Good Excellent
WRITE:
Fair Good Excellent
SIGN:
Fair Good Excellent
Do you have any friends/relatives working with our company?
Yes No
If yes, list name, relationships and locations: ____________________________________________________________________________________________
Who were you referred by? _________________________________________________________________________________________________________
Additional Comments: _____________________________________________________________________________________________________________
MONTH DATE YEAR
LAST FIRST MIDDLE
STREET CITY STATE ZIP CODE
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