Franchised Location

Application for Employment – TEAM MEMBER STANDARD

PLEASE TELL US ABOUT YOURSELF

Name (print) Last ___________________________________________ Middle I. _________ First _____________________________________Date _____________

Present Address ____________________________________________________________ City _______________________________ State _____ Zip ___________

Home Telephone ___________________________________________ Cell/Other Telephone (if applicable) ________________________________________

Email Address __________________________________________________________________________________________________________________________

Do you have a reliable means of transportation to work?  Yes  No What wage rate are you expecting? ______________________________

If you are younger than 18 years old, how old are you? ________________________________________________________________________________________

Are you legally authorized to work in the U.S.?  Yes  No

Have you ever been convicted of a felony?  Yes  No
If so, please indicate the crime, date of conviction, nature of circumstances, state in which offense occurred, and sentence (if any):

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

Note: Please do not answer yes or provide any information about convictions that have been erased, expunged, sealed, pardoned, set aside, vacated,
annulled or otherwise eradicated by a court.” A “yes” response will not necessarily disqualify an applicant from employment. Failure to answer this
question accurately could cause denial of employment or termination of employment.

AVAILABILITY

Monday: From __________ To __________ Tuesday: From __________ To __________ Wednesday: From __________ To __________

Thursday: From __________ To __________ Friday: From __________ To __________ Saturday: From __________ To __________

 Seasonal  All Year Limitations to Availability _____________________________________________________________________________

Minimum weekly number of hours needed to work ___________________ Maximum weekly number of hours able to work ______________________

PREVIOUS EMPLOYMENT HISTORY

Have you ever worked for a Chick-fil-A® , Inc. or a Chick-fil-A Franchisee?  Yes  No If YES, which Unit? _____________________________________

PLEASE LIST YOUR THREE MOST RECENT JOBS (including babysitting, lawn care or volunteer work):

Name & Address of Employer _____________________________________________________________________________________________________________

Employed From To Phone # Supervisor Wage rate Reason for Leaving

_____________ _______________ _______________________ ___________________________ _____________ ___________________________

Name & Address of Employer _____________________________________________________________________________________________________________

Employed From To Phone # Supervisor Wage rate Reason for Leaving

_____________ _______________ _______________________ ___________________________ _____________ ___________________________

Name & Address of Employer _____________________________________________________________________________________________________________

Employed From To Phone # Supervisor Wage rate Reason for Leaving

_____________ _______________ _______________________ ___________________________ _____________ ___________________________

Relevant skills
_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________
Application for Employment (continued)
EDUCATION
High School (Last attended) Location Did You Graduate?  Yes  No

___________________________________________ __________________________________________________________________________________________

College & Vocational Schools Location Did You Graduate?  Yes  No If yes, Degree & Major Grade Pt. Avg.

__________________________________ ____________________________________________________ ____________________________ _______________

__________________________________ ____________________________________________________ ____________________________ _______________

PERSONAL BACKGROUND

Please list job-related awards and/or leadership positions held (work or school)

_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

MILITARY SERVICE

 Yes  No Branch ______________________ Rank_____________________________________ Start Date ______________ End Date ______________

Relevant skills
_______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

REFERENCES

Please provide four references (for example, current or past employers or supervisors; teachers; others familiar with your job qualifications).

Name Address Phone Relationship Years Known

__________________________________ __________________________________________ ____________________ ___________________ ___________

__________________________________ __________________________________________ ____________________ ___________________ ___________

__________________________________ __________________________________________ ____________________ ___________________ ___________

__________________________________ __________________________________________ ____________________ ___________________ ___________

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN

I understand that I am applying for employment at this particular Chick-fil-A Restaurant location only and this location is operated by independent
franchisee. I further understand that completion of this application does not indicate that there are any positions currently open and does not obligate the
franchisee to hire me.

I certify that all of the answers given in this application are true and complete to the best of my knowledge and that I have personally completed this
application. I understand that providing false or misleading information or omitting pertinent information in my application or a job interview shall be
grounds for rejection of this application or for immediate discharge if I am employed.

I understand that if I am employed, my employment will be for no definite period of time. I understand that my employment may be terminated at-will with
or without cause, and with or without notice, at the option of either the franchisee or me.

I authorize all persons or businesses contacted by or on behalf of the franchisee about me or my application to disclose any and all performance
reviews, reports, and other documents and information related to my background, work history and qualifications, without giving me prior notice of such
disclosure. I also authorize the persons named herein as references and others of whom the franchisee may inquire about my background to provide the
franchisee with any pertinent information they may have regarding me. By signing below, I fully release the franchisee, my former employers and all
other persons, and businesses from any and all claims, demands or liabilities arising out of or in any way related to such references or disclosures.

______________________________ ____________________________________________________________________________________
Date Applicant Signature

The franchisee is an equal employment opportunity employer and considers all applicants without regard to race, color, religion, national origin, ancestry, citizenship, sex,
pregnancy, age, physical or mental disability, genetic information, service in the uniformed services, and/or any other protected status, classification or factor, in accordance
with the requirements of all federal, state and local laws.

Team Member Standard © 2006-2012 CFA Properties, Inc. Chick-fil-A and Chick-fil-A Stylized are registered trademarks of CFA Properties, Inc. [Rev. 11-12]