Application For Employment

Main Street Wings, LLC d/b/a Buffalouie’s is an Equal Opportunity Employer. All employment decisions including, but not limited to, hiring, promoting, and terminating, are made free from discrimination based upon race, color, religion, marital status, veteran status, creed, gender, sexual orientation, age, national origin, disability or any other legally protected status.

In answering questions contained within this application, you may exclude any information, which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status and in submitting your answers you should focus on the job-related functions of the position that you are applying for.

Employee Information

Name *

First

Last

Telephone *

Email *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

How Long at Current Address?

Previous Address *

Address Line 1

Address Line 2

City

State

Zip Code

If you have ever worked under any name (maiden name, et.) other than present, Please state:

Social Security Number *

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What position(s) are you applying for?

Earnings Expected

Reason for Applying

Are you legally eligible for employment in the State of Indiana? If not, please explain:

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Signature of Applicant *

Clear Signature

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Education

Name of High School + City / State

Did you Graduate from High School?

Last Year Completed

Major Area of study

College

Name of College + City / State

Did you Graduate from College?

Last Year Completed College

Major Area of study

Post College

Name of Post College School + City / State

Did you Graduate from Post College?

Last Year Completed Post College

Major Area of study

Name of Trade School + City / State

Did you Graduate from the Trade School?

Last Year Completed Trade Business School

Major Area of study

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Please indicate any periods during the past 10 years when you were not actively employed.

From When to When

From When to When II

From When to When III

From When to When IV

Reason for Inactivity

Reason for Inactivity II

Reason for Inactivity III

Reason for Inactivity IV

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Signature of Applicant *

Clear Signature

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Please list your last four positions beginning with the most recent.

Employer 1

Business Name

Type of Business

Employer 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Dates (From:)

Dates (To:)

Rate of Pay

Title and Department

Supervisor Name

First

Last

Supervisor Phone Number

Description of Duties

Reason for leaving

If currently employed, may we contact above employer and/or supervisor?

Yes
No

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions

Signature of Applicant

Clear Signature

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Employer 2

Business Name

Type of Business

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Dates (From:)

Rate of pay

Dates (To:)

Title and Department

Supervisor's Name

First

Last

Supervisors Phone Number

Description of Duties

Reason for Leaving

Employer 3

Business Name

Type of Business

Supervisor's Name

First

Last

Supervisor's Phone Number

Dates (From:)

Title and Department

Dates (To:)

Rate of pay

Address

Address Line 1

Address Line 2

City

State

Zip Code

Description of Duties

Reason for Leaving

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If the job position requires such, are you willing to be bonded at our expense?

May we contact your last employer?

Are there any obstacles, which would prevent you from starting employment?

On what date would you be available for work?

Have you ever entered a plea of no contest to a criminal felony charge within the last 7 years?

Have you ever been terminated or asked to resign from any job?

Please explain fully any gaps in your employment history:

I further understand that if I am employed by Main Street Wings, LLC d/b/a Buffalouie’s, any false answers or statements made by me on this application or supplement thereto will be grounds for my immediate discharge from such employment.

I understand that if employed by Main Street Wings, LLC d/b/a Buffalouie’s, my employment is for an indefinite term and is terminable at any time at the will of either the company or myself for any reason and that I am required to abide by all rules and regulations of Main Street Wings, LLC d/b/a Buffalouie’s.

I ALSO CERTIFY THAT I AM NOT PRESENTLY SUBJECT TO AN EMPLOYMENT CONTRACT, RESTRICTIVE COVENANT, CONFIDENTIALITY AGREEMENT OR ANY OTHER AGREEMENT WITH ANY COMPANY AND THERE IS ABSOLUTELY NOTHING THAT WILL PREVENT ME FROM ACCEPTING A POSITION WITH MAIN STREET WINGS, LLC d/b/a BUFFALOUIE’S IF IT SHOULD BE OFFERED TO ME.

I also understand and agree that no representative of Main Street Wings, LLC d/b/a Buffalouie’s has any authority to enter into an agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

This application is current for only 60 days, at the conclusion of this time, if I have not heard from Main Street Wings, LLC d/b/a Buffalouie’s and still wish to be considered for employment, it will be necessary to fill out a new application.

I give Main Street Wings, LLC d/b/a Buffalouie’s the right to contact and obtain information from all references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

Signature

Clear Signature

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Date

Employee Information

Employer 1

Employer 2

Employer 3

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