
All applicants for employment by Cracker Barrel Old
Country Store
®
must consent to background verifications.
This form serves to provide necessary information in order to
conduct the background verifications.Your accuracy and
thoroughness will help expedite the processing of your
application.
Please complete the following information. It is requested
that you complete all information on this sheet even if it is
already included on your application form or resume. Note:
Date of birth and maiden name are not considered in the
employment decision.This information is utilized for accurate
records verifications only.
Your Name
SS#
Your Address
Daytime Telephone ( ) —
Evening Telephone ( ) —
College
Location
Degree
❏
No
❏
2 - Year
❏
4 - Year
❏
Graduate Degree
Last Mo./Yr.Attended
Telephone ( ) —
Date of Birth / /
Drivers License #:
State
Maiden Name or Other Name Used:
Year this name was last used:
I request that this document in its original or
copied form serve as my valid authorization to
any and all persons, educational institutions, past
and/or current employers, organizations, credit
reporting agencies, law enforcement or criminal
record agencies, and other agencies to release
information about me to a third party agency or
its designated agent, and hereby release all
persons, institutions, agencies, employers, and
organizations providing such information from
liability in any or all claims and damages
connected with their providing any requested
information.
Authorized by candidate:
Signature
Date Signed / /
Cracker Barrel Old Country Store
®
Cracker Barrel Old Country Store, Inc. recruiter name
All references you list are subject to contact
as part of our pre-employment process.
Please furnish current telephone numbers
for references.
1. Name
Title
Phone ( ) —
Company Name
Company Address
Employment Dates
Your Position
Salary
2. Name
Title
Phone ( ) —
Company Name
Company Address
Employment Dates / /
Your Position
Salary
3. Name
Title
Phone ( ) —
Company Name
Company Address
Employment Dates / /
Your Position
Salary
Background Verification
Three Past/Current Employment Supervisors
Please Print All Information
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