Employment Step 1 of 4 25% EmploymentSoupley's Inc. is an equal opportunity employer and does not discriminate against any individuals in any phase of employment in accordance with the requirements of local, state, and federal law.Application Date: MM slash DD slash YYYY Date Available: MM slash DD slash YYYY Type of work desired: Full-Time Part-Time Temporary Summer Select AllReferral Source: Employee Walk-In Advertisement Other Personal Information:Name: First Last Previous Name(s): First Last Email Present Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number: Is there any day or shift you CAN NOT work?Have you ever been employed by Soupley's before? Yes No If so, when?Are you available to work nights 4pm - 12am?YesNoAre you available to work weekends?YesNoDo you have any relatives or friends employed at Soupley's? Yes No Who?Are you at least 21 years of age? Yes No Have you ever been convicted of operating a motor vehicle while intoxicated in the last 10 years?YesNoPlease provide dates and case informationIf hired, can you furnish proof that you are of legal age to perform the job for which you are applying? Yes No If hired, can you furnish proof that you are legally entitled to work in the U.S.? Yes No As an essential part of employment, are you able to lift 35 pounds? Yes No EducationHigh School:Number of Years:Degree or Certificate:DegreeCertificateField(s) of Study Major/MinorCollege(s) OR Universities:Number of Years:Degree or Certificate:DegreeCertificateField(s) of Study Major/MinorBusiness OR Trade School (incld. Military):Number of Years:Degree or Certificate:DegreeCertificateField(s) of Study Major/MinorSpecial Courses OR Other Training:Number of Years:Field(s) of Study Major/MinorDegree or Certificate:DegreeCertificateIf you are currently in school, when will you complete your program? Employment HistoryList your last four (4) employers, assignments, or volunteer activities, starting with the most recent, including military experience.From Date: MM slash DD slash YYYY To Date: MM slash DD slash YYYY EmployerTelephoneJob TitleAddressImmediate Supervisor/TitleSummarize the nature of work performed and job responsibilities:Reason for leaving:Hourly Rate- StartHourly Rate - FinalFrom Date: MM slash DD slash YYYY To Date: MM slash DD slash YYYY EmployerTelephoneJob TitleAddressImmediate Supervisor/TitleSummarize the nature of work performed and job responsibilities:Reason for leaving:Hourly Rate- StartHourly Rate - FinalFrom Date: MM slash DD slash YYYY To Date: MM slash DD slash YYYY EmployerTelephoneJob TitleAddressImmediate Supervisor/TitleSummarize the nature of work performed and job responsibilities:Reason for leaving:Hourly Rate- StartHourly Rate - FinalTo Date: MM slash DD slash YYYY From Date: MM slash DD slash YYYY EmployerTelephoneJob TitleAddressImmediate Supervisor/Title:Summarize the nature of work performed and job responsibilities:Reason for leaving:Hourly Rate- StartHourly Rate - FinalConsent I agree to the privacy policy.I certify that the information given on this application is true and complete to the best of my knowledge. I authorize the organizations or persons named in this application to give any information regarding my employment, education, or records. I release said organizations or persons from all liability for any damage for issuing this information. I understand that falsification or misinformation herein may be cause for denial of employment or for termination of employment. I understand that this employment application is not a contract and that it contains no representation of future or continued employment. Should I be hired by Soupley's Inc. I understand that my employment may be terminated at any time, with or without cause, with or without notice, at the option of either the company or myself. I understand that this application is active for 30 days. I understand that no manager or representative of Soupley's Inc. other than an officer of Soupley's Inc., has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing.Applicant's SignatureDate MM slash DD slash YYYY
