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    © All Rights Reserved
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    18 views4 pages

    Harmony Tea Bar Pre-Interview Forms

    Uploaded by

    J.C C.G.
    Shmoop

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 4

    Harmony Tea Bar

    Statement of Values

    Dear Applicant:

    Welcome to Harmony Tea Bar. Prior to completing the application for employment, please un-
    derstand that we are serious about creating a productive working environment for our staff and
    maintaining the highest levels of quality, service and attention for our guests.
    We want you to understand that we also believe in living our values, some of which are:
    • We believe that "good enough" isn't.
    • We believe in doing business in a professional and orderly manner.
    • We believe in honesty and integrity.
    • We believe that only a happy and professional staff can give the level of personal service
    we demand.
    • We believe in the ongoing training and development of our staff and see it as a worthy
    investment in the future of the company.
    • We believe in providing legendary service - the unique and powerful sort of personal
    care and attention that our guests tell stories about.
    • We believe that everyone is capable of being an A+ player.

    If this feels like an environment for you, please complete the application.
    Harmony Tea Bar - Application for Employment
    We consider opp/JCllnts for oB pos/dons witl,011t regord to nee, color, reUgion, 11ex, nodonol origin, oge, disobilily, veteron sllllllll or •ny otl,er legolly prot«ud s11111111.

    ** PLEASE PRINT CLEARLY**


    Location applying for: Mission Viejo Laguna Beach Both Dare--'-/-----=--/_ _ __
    How did you fmd out about this job? Newspaper Employee Walk-in Relative Other _ _ _ _ _ _ _ __

    Why are you seeking a new job at this time? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -===


    (A~plicant Information
    First Name _ _ _ _ _ _ _ _ _ _ _ Middle _ _ _ _ _ _ _ _ _ _ _ _ Last _ _ _ _ _ _ _ _ _ __

    Street Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Social Security No. _ _ _ _ _ _ _ _ _ _ _ _ _ __

    City/State/Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone L__) _ _ _ _ _ _ _ _ _ _ __

    If hired, do you have a reliable means of transportation to get to work? _ _ _ _ _ _ Describe _ _ _ _ _ _ _ _ _ __

    Do you use a smartphone? iPhone / Android / Other

    Are you at least 18 years old? _ _ _ If you are under 18 years of age, can you furnish a work permit? _ _ _ _ _ _ _ __
    Are you legally eligible for employment in the U.S.? _ _ _ (Proof of U.S. citizenship or immigration status is required if hired.)
    Have you been convicted of a crime? (Applicants should not include marijuana-related convictions that occurred more than 2 years
    prior to the application date or convictions that have been sealed, expunged, or statutorily eradicated.) Yes No
    If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record
    does not constitute an automatic bar to employment.)

    Are you a veteran? _ _ _ _ _ _ _ _ If yes, give dates of service: From _ _ _ _ _ _ To _ _ _ _ _ _ _ _ __

    List any special skills or training: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

    Em ~loiment lnfo
    ;:;,.;r. ;m
    :;. :. ;a:.;.:t:io
    .:. .::...:n_______;...::........;..___.:._____;__
    Are you seeking full time, part time or temporary employment? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    What hours and shift(s) would you prefer to work? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    List times you are not available to work? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    Are you willing to work overtime? _ __ Weekends? Holidays? _ _

    Are you currently employed? _ _ __ If hired, when would you be able to start? _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    Have you ever worked for this organization before? _ __ If yes, name used: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    List any friends or relatives employed by this company: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    Have you ever been discharged or asked to resign from any position? _ _ _ _ If yes, please describe: _ _ _ _ _ _ _ __

    Please respond only if a job description is attached for the position for which you are applying. Are you able to perform all these tasks
    with or without reasonable accommodation? _ _ Please describe which tasks, if any, you will need accommodation to perform, and
    explain what type of accommodation you will need: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    Please describe:
    ----------------------------------------
    Education . .;._. . ;.; ,; ;.;. ;,. ; .:;!__~-----------------------------.J
    (circle highest level achieved)

    Elementary: 1 2 3 4 5 6 7 8 Secondary: 9 10 11 12 G.E.D College: 1 2 3 4 5 6 7 8

    Name of School: _ _ _ _ _ _ _ _ _ Name of School: _ _ _ _ _ _ _ __ Name of School: _ _ _ _ _ __

    Location of School: Location of School: - - - - - - - - Location of School: _ _ _ _ __


    If in high school, are you enrolled in a recognized co-op program? Yes No Degree & Major: _ _ _ _ _ __
    Minor: _ _ _ _ _ _ _ _ _ __
    If yes, identify program and school:
    -------------------
    Work History (please begin with most recent)
    1. Company _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone No. with Area Code 1...__ ___.i!...___ _ _ _ _ _ _ __
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City/State/Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    Address
    Dates of Employment: From _ _ _ _ _ _ To _ _ _ _ __
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Supervisor's Name & Title _ _ _ _ _ _ _ _ _ _ _ __
    Job Title
    Describe duties briefly:
    Specific reason for leaving:
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone No. with Area Code l...__ ___J[..__ _ _ _ _ _ _ __
    2. Company
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City/State/Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    Address
    Dates of Employment: From _ _ _ _ _ _ To _ _ _ _ __
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Supervisor's Name & Title _ _ _ _ _ _ _ _ _ _ _ __
    Job Title
    Describe duties briefly:
    Specific reason for leaving:
    3. Company _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone No. with Area Code .,,____ _____.'-------------
    Address - - - - - - - - - - - - - - - - - - - - City/State/Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    Dates of Employment: From _ _ _ _ _ _ To _ _ _ _ __
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Supervisor's Name & Title _ _ _ _ _ _ _ _ _ _ _ __
    Job Title
    Describe duties briefly:
    Specific reason for leaving:
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone No. with Area Code .,,____-----''----------
    4. Company
    Address - - - - - - - - - - - - - - - - - - - - City/State/Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    _ _ _ _ _ _ To _ _ _ _ __
    Dates of Employment: From
    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Supervisor's Name & Title _ _ _ _ _ _ _ _ _ _ _ __
    Job Title
    Describe duties briefly:
    Specific reason for leaving:

    -I For references purposes: Have you worked for any of these organizations or attended school under a different name? _ _ __
    If yes, give name and organization(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    May we contact the employers listed above? __ If not, list the employers you do not wish us to contact and why:
    ~-__,;;._-__;___,__.'I
    11

    ~ uthorizations & At-Will Emiiloy.=m


    . =-:.:::e:.:.:n~t .A:.
    :;.. ;c;iigt.re
    :. ;=-=e:.:.:m:.:.:e:: .;n:.;.;:t;.,_____.
    (please read carefully, then sign and date below)
    I certify that I have personally completed this application. I declare that the information provided in this employment application is
    true and complete and I understand that any false information or significant omissions may disqualify me from further consideration
    for employment and may be justification form my dismissal from employment if discovered at a later date. I agree to immediately
    notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired.
    I authorize this company to make an investigation of all information contained in this employment application and I release from
    liability all companies and corporations supplying such information. I understand any false answers, statements, or implications
    made by me on this application or other required documents shall be considered sufficient cause for denial of employment or dis-
    charge.
    I specifically authorize and direct my current and former employers to supply employment-related information to this company and
    do hereby release my current and former employers from liability for providing information to this company.
    Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information
    concerning my employment to any potential employer.
    I authorize this company, if applicable, to request my motor vehicle driving record. As required by law, upon request within area-
    sonable period of time, I will be notified as to the nature and scope of such investigations.
    I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any
    time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical
    treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby
    authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and
    a company-designated physician.

    AT-WILL EMPLOYMENT AGREEMENT


    I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an em-
    ployment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration ofmy
    employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time,
    for any reason, or for no reason at all. I understand that only the company's President is authorized to change the employment-at-
    will status and such a change can only be done in writing signed by the President. I have read, understand, and agree to the above.

    Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ __

    Name (please print) _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

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