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Application for Employment

Ox Yoke Inn, Inc. does not discriminate based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status or any other legally protected status.

PERSONAL INFORMATION

Check which location you are applying at:*   Ox Yoke Inn, 4420 220th Trail, Amana  
Ox Yoke Innterstate, I-80 Amana Exit 225, 2206 U Avenue, Williamsburg  
Date of Application:  September 7, 2010
Position(s) applying for:*  
How Did You Learn About Us?* Advertisement - where
Walk-In  
Relative
Current Employee's (name)
Other
Name:*  

Last
First
Middle
Address:*  

Street

City
State
Zip Code
Telephone:*  
Mobile Telephone:*     Alt. Telephone:  
Email:*  
Are you 18 or older, or if you are under 18 years of age, can you provide required proof of your eligibility to work? :*   Yes   No
Name and Address of Parent or Guardian if applicant is a minor:  
Name(s)

Street

City
State
Zip Code
Have you ever been employed with us before?*   Yes   No
If yes, give dates:  
Are you currently employed?*   Yes   No
May we contact your present employer?*   Yes   No
Do you have legal right to work in the United States?*   Yes   No
On what date can you start to work?  
Please check the shifts you are available to work (hours may vary):* Full Time:   Part Time:   On Call or Temporary:
ShiftMonTueWedThuFriSatSun
Breakfast Daily (Innterstate Only)
Sunday Brunch (Amana Only) N/AN/AN/AN/AN/AN/A
Lunch
Dinner
Notes  
Will you work overtime if asked?*   Yes   No
Are you currently on "lay-off" status and subject to recall?*   Yes   No
Have you been unemployed for more than a month at any one time?*   Yes   No
If yes, please explain.  
Have you been convicted of a crime in the past ten years, excluding misdemeanors and traffic violations?*   Yes   No
Note: A conviction will not necessarily disqualify an applicant from employment
If yes, please explain:  

EDUCATION

Name and Location of school/institution
(Name,City & State)		Course of studyGraduate?Check Year Completed
High School

Yes
No

9
10
11
12
Tech or Trade School

Yes
No

1
2
3
4
Name and Location of school/institution
(Name,City & State)		MajorDegreeGraduate?Check Year Completed
College/ University

Yes
No

1
2
3
4
College/ University

Yes
No

1
2
3
4
Additional job-related seminars, short courses, workshops, or other educational experiences?  
Describe any specialized training, apprenticeship, skills and extra-curricular activities.  

Other Qualifications:

Summarize special job-related skills and qualifications acquired from employment or other experience.  

EMPLOYMENT EXPERIENCE

Start with your present or last job and include all jobs held in the last ten years. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer (present or most recent):*  
Address:*

Street
City
State
Zip
Job Title:*   Telephone:*  
Supervisor:*  
Dates employed From (month/year):*  / To (month/year): /
Salary:* Starting Final
Work Performed:*  
Specific Reason for Leaving:*  
Are you eligible for rehire?*   Yes   No
Employer:  
Address:

Street
City
State
Zip
Job Title:   Telephone:
Supervisor:  
Dates employed From (month/year):  / To (month/year): /
Salary: Starting Final
Work Performed:  
Specific Reason for Leaving:  
Are you eligible for rehire?   Yes   No
Employer:  
Address:

Street
City
State
Zip
Job Title:   Telephone:
Supervisor:  
Dates employed From (month/year):  / To (month/year): /
Salary: Starting Final
Work Performed:  
Specific Reason for Leaving:  
Are you eligible for rehire?   Yes   No
Employer:  
Address:

Street
City
State
Zip
Job Title:   Telephone:
Supervisor:  
Dates employed From (month/year):  / To (month/year): /
Salary: Starting Final
Work Performed:  
Specific Reason for Leaving:  
Are you eligible for rehire?   Yes   No

REFERENCES

References - Who are not related to you and are not previous employers.
Reference:*  

Name		 ()-
Phone
Address:*  

Street
City
State
Zip
Reference:  

Name		 ()-
Phone
Address:  

Street
City
State
Zip
Reference:  

Name		 ()-
Phone
Address:  

Street
City
State
Zip
List friends and/or relatives presently employed by the Ox Yoke Inn, Inc.:  
State any additional information you feel may be helpful to us in considering your application.  

AGREEMENT

READ STATEMENTS BELOW CAREFULLY BEFORE SUBMITTING THIS APPLICATION.
  • I hereby certify that the information that I have provided in this employment application is true and correct to the best of my knowledge, and that I have not withheld information that would, if disclosed, affect this application unfavorably.
  • I understand that falsified or intentionally misleading information in any detail or significant omissions from this application may disqualify me from further consideration for employment or may result in my termination if discovered after my hire. I agree that The Ox Yoke Inn, Inc. shall not be liable for disqualifying or terminating me under such circumstances.
  • I authorize The Ox Yoke Inn, Inc. to investigate my personal, educational and employment history; I agree to cooperate in such investigation; and authorize any former employer, school, person, firm, corporation, credit agency, government agency, or other entity to provide The Ox Yoke Inn, Inc. with any information it, he or she may have about me, to the full extent permitted by applicable law. In consideration of The Ox Yoke Inn's review of this application, I hereby release to The Ox Yoke Inn, Inc. its agents, and all providers of information from any liability that results from furnishing or receiving this information, except as otherwise limited by applicable law.
  • I understand that my employment can be terminated for any reason, with or without notice, at any time, at either the Company's or my option.
  • I further agree that, if employed, I will conform my conduct to The Ox Yoke Inn's rules and regulations.
  • I have read the Applicant Agreement, and understand and agree to its terms.
I have read and agree to these statements.*

Our company maintains an active application file for one (1) year. If you wish to activate your application for any position during that time, please notify the Human Resources Office.

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