APPLICATION FOR EMPLOYMENT                                   
Herrick Foods Inc.
 Independently owned and operated as a Jack In The Box franchisee
Phone   805-484-9339
Fax  805-484-9236
 


We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

Applicant Name:
Address:
City, State, ZIP:
Date available to start:
Social Security:
Phone: (home / cell)
Email Address:
Position Desired:
  Cook     Line Server     Cashier    Sup.
What JACK IN THE BOX are you applying for? List which Location
Agoura, Camarillo (Santa Rosa, Los Posas, Daily?) , Oxnard (Vineyard Ave), Santa Paula, Port Hueneme or any
When are you available to work?

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Full Time (more than 30 hours/ week)
 Part Time (less than 30 hours/week)

 AM
 PM		 AM
 PM		 AM
 PM		 AM
 PM		 AM
 PM		 AM
 PM		 AM
 PM

Yes   No		  Are you able to meet the attendance requirements?
Yes   No  Do you have any objection to working overtime if necessary?
Yes   No  Can you submit proof of legal employment authorization and identity?
Yes   No  If you are under 18, can you furnish a work permit if it is required?
Yes   No  Have you ever been previously employed by our organization?
Yes   No  Have you ever been convicted of a crime in the last 7 years?
   If yes, please explain (a conviction will not automatically bar employment
EMPLOYMENT HISTORY: (most recent)
  Dates of Employment
  Position
  Pay Rate
  Business Name
  Address
  Phone
  Supervisor Name
  Reason for leaving
EMPLOYMENT HISTORY: (prior)
  Dates of Employment
  Position
  Pay Rate
  Business Name
  Address
  Phone
  Supervisor Name
  Reason for leaving
EDUCATION:
   (List school name and location, years completed, course of study, and any degrees earned)
   High School
   College / University
   Technical Training
OTHER SKILLS AND QUALIFICATIONS:
(Summarize any job-related training, skills, licenses, certificates, and/or other qualifications that may apply) 
REFERENCES:
(List 3 references names, telephone numbers, and years known (not including relatives)

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization before being hired. Failure to submit such proof within the required time shall result a "no hire". I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.