APPLICATION FOR EMPLOYMENT
In compliance with Federal and State equal employment opportunity laws, applicants are considered for positions without discrimination on the basis of race, religion, sex, national origin, citizenship, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws.
In order for you to be considered for employment, this application must be filled out COMPLETELY. Please write “N/A” if information is not applicable. Résumés, though welcome, should not be submitted in place of the information requested below.
* Denotes Required Information
*Last Name
*First
Middle
*Social Security # *Today's Date04/19/2014
*Current Address Street/PO Box
Apt#
*City
*State
*Zip
*Mailing Address (if different from above) Street/PO Box
Apt#
*City
*State
*Zip
Day Phone No Evening Phone No
Alternate Phone No
Email Address:


Yes, I would like to receive email updates from Bob Evans Farms.
Type of Work Desired: Full-Time Part TimeDate Available to Start
Position Desired: What is the starting minimum hourly rate/salary you are expecting to earn?

$ Per Hour Per Year

Are you under 18 years of age? Yes NoIf required, can you provide a valid minor work permit? Yes No
The Company does not employ minors under age 16. Minors are not permitted to work unless they are legally able to do so under all applicable state and federal laws. A minor may only be permitted to work in accordance with the terms, restrictions and limitations set forth in their work permit, if one is required.

Preferred Location



1. Are you willing to relocate? (Relocation is not required.) Yes No
If yes, where would you most prefer to relocate? First choice: Second choice:

2. Are you willing to submit to a background check, which includes a criminal, and motor vehicles records search if a job offer is extended? Yes No

3. Have you ever applied to or been employed by Mimi’s Café or Bob Evans Farms, Inc? Yes No
If yes, when and where?

4. Please list the name and location of any friends or relatives who are currently working or have worked for us.
Name Phone
Location
Name Phone
Location

5. Because the hours and shifts are so varied, it is necessary for you to have a reliable method of transportation. Do you have reliable transportation? Yes No

6. You may be required to drive. Do you have a valid driver’s license? Yes No

7. How many hours per week do you expect to work?

8. Please circle/highlight any days or nights you are NOT available to work in the table below.
Day Evening

MON
TUE
WED
THUR
FRI
SAT
SUN
FROM

TO



9. Our Company has locations that are open most holidays. Are you willing to work holidays and weekends? Yes No

10. Have you ever been terminated from a job? Yes No
If yes, how many times?
If yes, please explain

Applicants in California, District of Columbia, and Georgia should read the following information BEFORE answering question 11:

California: Do not identify convictions under California Health & Safety Code §§11357(b) or (c), 11360(b) (formerly subdivision (c) of section 11360), 11364, 11365, or 11550 related to marijuana offenses that occurred two or more years before the submission of this employment application.

District of Columbia: Do not identify a conviction that is more than ten (10) years old at the time of making this application. DC ST §2-1402.66.

Georgia: Do not identify any conviction that is considered a first offender discharge under §42-8-63 of the Georgia Code.

11. Have you been convicted of a felony that has not been annulled, eradicated, expunged, sealed by the court, or referred to a diversion program? Yes No
    Conviction will not necessarily disqualify an applicant from employment. Factors such as the age and time of the offense, seriousness and nature of the violation and rehabilitation will be considered when making any employment decisions. If your answer is “yes,” please explain the circumstances surrounding such offense, including place, date, name of court, etc.

12. EDUCATION
 
Name & Location of School

Course of Study
Years Completed

Complete Course?
High school
Yes No
College
Yes No
Vocational or Other
Yes No


13. Can you perform the essential functions required by the job for which you are applying either with or without reasonable accommodation(s)? Yes No
If necessary, please describe the type(s) of reasonable accommodation(s) that may be needed?

14. Do you have any special skills, experience and/or training that would enhance your ability to perform the job for which you are applying? Yes No

If yes, please explain:

15. WORK HISTORY
Please complete all information,
even if listed on resume.
Current or Most Recent EmployerPrevious PositionPrevious Position

Name of Employer
(If restaurants, note type; eg. fast food, owner-operated, multi-unit, full-service)

Address/Location

Supervisor's Name

Telephone and Fax NumberPhone

Fax
Phone

Fax
Phone

Fax

May we contact this employer? Yes No Yes No Yes No

Position's heldPosition

From
To
Position

From
To
Position

From
To

Total Actual Annual or
Hourly Rate

Average Number of hours
worked per day/week

Describe any work related awards, achievements or promotions

Reason for leaving (if currently employed, why do you want to leave?)

The following questions are for management applicants only

What department(s) did you manage?

Number of employees managed

For Restaurants - Average Weekly Sales Volume

16. Management Applicants only: Do you agree, if you are employed, that you will not bring into any facilities confidential information of any third parties that relates in any way to the business and will enter into an agreement with the Company to keep confidential all Company confidential information, and not disclose third-party confidential information? Yes No

Note to Maryland Applicants:
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

Please Read the Following Carefully and Sign Below
I declare that I am qualified to perform all the duties of the position I am seeking with or without reasonable accommodation. I also declare that the information provided in this Application is correct and that any false statements or omissions will justify my rejection for or dismissal from employment. I agree to keep the information provided in this application updated and accurate at all times while this application is active. I authorize the Company to conduct any necessary investigation regarding my background (including inquiries of me, prior or current employers, schools and other persons, institutions, or businesses, and checking motor vehicle records, court records and criminal records) as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms for any background investigation. I hereby release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Company as well as from the use or disclosure of such information by the Company or any of its agents, employees, or representatives. I will agree to a post-offer, pre-employment drug test, if permitted by law, to be paid for by the Company. I further agree that the results of any drug tests to which I may be subjected during my employment may, consistent with applicable law, be used to make employment decisions, including decisions relating to hiring and continued employment.

I understand and agree that this Application for employment does not create a contract for employment or a guarantee of employment. I understand and agree that if I am hired, my employment is “AT-WILL” which means that my employment is for no definite period of time and either the Company or I may terminate the employment relationship with or without cause at any time, with or without any advance notice. I understand that only the CEO may change the AT-WILL status of any applicant or employee and may only do so in writing.

I understand that any policies or procedures implemented by the Company in the event of my employment do not alter my AT-WILL employment status. I understand that the Company, in its sole discretion, may at any time change its personnel policies and may also change my job description, responsibilities, wages, and benefits. I understand that all offers of employment are conditioned on satisfactory proof of an applicant’s identity and legal authority to work in the United States and, if applicable, the receipt of satisfactory completion of a background check.

I authorize the Company to communicate with me at the email address provided by me, which is my private personal email address. I also authorize the Company to leave messages at the phone numbers provided by me.
Except where prohibited by law, I agree that any claim or lawsuit relating to my employment with the Company must be filed no more than six (6) months after the date of the employment action that is subject of the claim or lawsuit. I waive any statute of limitations to the contrary except where prohibited by law.

I HEREBY ACKNOWLEDGE AND UNDERSTAND THE NOTICE AS DESCRIBED ABOVE AND THAT IF I AM HIRED I WILL BE AN AT-WILL EMPLOYEE.

Bob Evans is an equal opportunity employer.
M/F/D/V