[PDF] [PDF] APPLICATION FOR EMPLOYMENT Date,_ _ __ FIVE GUYS

Number I Supervisor Name:

GYes GNo

Dates Worked I What Did You Do?

From: To:

Last Salary I Wage Hourly Or Monthly

Signed By:" ',' '''.;"0 ' 'pate>' ..'..

J NAME OF COMPANY CITY STATE

G Yes G No

Dates Worked IWhat Did You Do?

To: Last Salary I Wage Hourly Or Monthly

Why Did You Leave?

Co. proVIdes equal employment opportumtles WIthout regard to race, sex, age, na1!onal ongIn, citizenship, religIOn, dlsablhty, sexual onenta1!on, or veteran status, and make

Page 1of 2

Name Relationship City, State Telephone

Home: (

Work: ( )

Home: (

Work: ( )

Home: (

Work: (

1. G Yes G No 'I Within the las:r? years: ba\iIilXOU" been'convicted-of"a stalking;_ininors-;---:-

.\ Conviction';of a crime will not ne6essarllY'disqucllify youfrc;mcorrsideration for employment and will be considered only as it relates to the job in question, ;

Relationship

Telephone Address

Nature

of My Employment. If I work for Co, as an employee, ,I agree and understand that I will be an at will employee, which means that either I or Co. may end my

employment at any time, with or without cause or notice. I agree that the company through an act of employing me, or by me becoming and employee of the company

will not constitute an express or implied contract of employment, I further agree that no written materials or verbal statements made by any employee, agent, or

member cf management for Co., will constitute an express or implied contract of employment and that this at will relationship could only be modified in a writing

identifying me by name and signed by the Chief People Officer of Co.. I also agree that I will treat confidentially all information I will learn in the course of my

My Participation in Co.'s Drug Free Environment I am not a current user of Illegal drugs, and I agree I will never work under the Influence of 1II0gai drugs orundor the Influence alcohol. I agree to

to any laWful test tor Illegal use at arug., or working under the Influence of alcohol. I agree that Co. may refuse to hire me, or may terminate my employment If I fall, or refuse to submit to,

at anytime. If hired I agree, to undergo substance screening for Illegal drugs ill am involved in an accident at work or if management thinks I contributed In any way to cause an accident

My Records and References. There is nothing in my background that would cause a risk to Co.'s customers, employee, or property. I have not committed an act of

violence, harassment or discrimination within the last seven years. I authorize Co. to conduct reference checks, to request and receive from federal, state, county,

and local government, and private companies, reports and confidential information regarding me, criminal records, driving records, and other consumer reports,

including personal interviews and other information relating to my character, general reputation and credit, personal characteristics and mode of living. Further, I

Co. and all parties companies and persons from any and all liability for any damages that may result from anyone furnishing such information to the company,

as well as the company, from the use or disclosure of such information by the company or any of its agents, employees, or representatives.

I agree

to promptly notify Co. of any complaints. If later, someone makes a complaint about me, regarding an act of violence, harassment or discrimination, or if

am later convicted of a crime involving a felony, which includes but not limited to crimes involving, sex, stalking, minors, thief, property damage, or drugs. Or (if I am

The information on this application is true and correct. I understand acknowledge and I agree that misrepresentation or any false information, omission cf facts,

or falsification of this information or company records now or in the future, allows Co. to refuse to hire me and if an employee is cause for dismissal and/or

agree that a photocopy or imaged copy of this signed agreement will be as valid and enforceable as the original.

ARBITRATION

OF APPLICANT OR EMPLOYEES RIGHTS

Because of the delay and expenses of the court systems, The Company and I agree to use confidential binding arbitration for any claims that arise between me and

Company, Its related companies, and/or their current or former employees. Such claims would include any concerning compensation, and other employmenVemployee

claims (including, but not limited to any claims concerning Discrimination Sexual Harassment Or wrongful Termination.), or termination of employment or olher acts

classified as torts. Before arbitration, I agree (#1 ) first, to present any such claims, or complaints in full written detail to Co.: (#2 ) NEXT, AS AN APPLICANT, EMPLOYEE,

OR FORMER EMPLOYEE, TO COMPLETE ANY Co. INTERNAL REVIEW PROCESS; AND {#3} FINALLY, TO COMPLETE ANY EXTERNAL ADMINISTRATIVE

REMEDY PROVIDED BY a Human Resource Consulting Company. After complying with #1 and #2 And #3 above the company and I agree to use confidential binding

arbitration as of that date and time I accept the then prevailing rules of the American Arbitration AsSOCiation (and, to the extent not inconsistent, the then preVailing rules of

To be considered for employment this application will be active for 30 days, I understand that I must contact the company to

updatelrenew the application after 30 days. I have read and understand the forgoing notice concerning my as an applicant.

Applicant's Signature:

Page20f 2

FIVE GUY

BURGERS and FRIES

Burlingame CA

Safeway Shopping Center

203 Primrose Drive Burlingame CA 94010

Tel: (650) 343·3016

BURGERS <

FRIES DRINKS

LARGE(1,314cal) $4.99 ::

Time Out New York '08

GO Magazine '09 The State (Columbia, SC) '05

Voted Best French Fries Voted Best French Fries

Montana Kaiman '11 New Jersey Monthly '11

Boston.com'12 Cenla Focus '12

Star-Telegram,com

Reminder. Consuming raw or undercooked poultry, meal, eggs, shellfish or seafood may increase your risk of loodborne iI/ness.