Employment Application
PERSONAL INFORMATION NAME OF EMPLOYER:
Name (Last) First (Middle) Date
/ /
Home Address City State Zip
Home Telephone Cellular Phone Business Phone May we contact you at work?
( ) ( ) ( ) Yes No
E-mail
Position Applying For Date Available Are you interested in (check all that apply)
Full-time Part-time Temporary Summer
Days and hours available. Complete if applying for restaurant position.
Day Mon Tues Wed Thurs Fri Sat Sun
Are you willing to relocate? Yes No
From Are you 18 years or older? Yes No
(no one under age 16 may be hired)
To
How were you referred to us?
EDUCATION
Type of School Name and Location of School Degree/Area Number of Graduated
of Study Years Attended (Check One)
Name Address
High School City State Zip
Yes No
Name Address
College City State Zip Yes No
Name Address
Graduate School Yes No
City State Zip
Name Address
Other City State Zip Yes No
U.S. MILITARY SERVICE
Branch of Service Technical Specialization Rank Attained
LEGAL
Are you legally authorized to work in the United States? Yes No (Identity and employment eligibility of all new hires will be verified as required by the
Immigration Reform and Control Acts of 1986.)
Were you ever discharged by any company? Yes No If yes, give name of company(ies)
Reason for discharge
Have you ever been convicted of or plead guilty to (including a plea of nolo contendere) a misdemeanor Yes No If yes, please explain in full:
at any time within the past 5 years?
Have you been convicted of or plead guilty to (including a plea of nolo contendere) a felony (you are not obligated Yes No If yes, please explain
to disclose sealed, erased or expunged records of conviction(s) or records of arrests or criminal charges which did not result in offense and final disposition:
a conviction)?
(A conviction will not necessarily disqualify an applicant from employment.)
(CONTINUED ON BACK)
Federal, State, and local laws prohibit discrimination based on race, color, sex, religion, affectional or sexual orientation, national origin, ancestry, age, physical or mental
disability that does not affect ability to perform essential job function(s) with or without reasonable accommodation, or any other protected status not listed in this
statement. Your application will be considered in full accord with applicable Federal, State, and local requirements.
EMPLOYMENT HISTORY
List employment starting with your most recent position. You may include a description of verified work performed on a volunteer basis.
Is any additional information relative to a different name necessary to check your work record?
If yes, explain. Yes No
DATES NAME AND ADDRESS POSITION HELD LIST MAJOR SALARY OR REASON
OF EMPLOYER AND SUPERVISOR DUTIES WAGES FOR LEAVING
From: Name Your Job Title Starting
mo. yr. Address
To: Supervisor Final
City & State Phone
mo. yr. ( )
From: Name Your Job Title Starting
mo. yr. Address
To: Supervisor Final
City & State Phone
mo. yr. ( )
From: Name Your Job Title Starting
mo. yr. Address
To: Supervisor Final
City & State Phone
mo. yr. ( )
From: Name Your Job Title Starting
mo. yr. Address
To: Supervisor Final
City & State Phone
mo. yr. ( )
Have you previously worked for Dunkin’ Donuts or any of its subsidiaries or Franchisees? Yes No
Name Location
City & State Position Held
Supervisor Dates Employed From: To:
Reason for Leaving
REFERENCES
Business references: (do not list relatives)
Name Address Work Phone No. Title Years Known
PLEASE READ CAREFULLY
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I
understand, also, that I am required to abide by all rules and regulations of the Franchisee of Dunkin’ Donuts.
I understand and agree that if employed, employment will be “AT WILL.” That is, either I or the employer may end the employment relationship at any time, for
any reason, or for no reason. I understand that receipt of this application does not imply employment and that this application and/or any other documents are not
contracts of employment.
I understand that I am applying for work with (one or more) Dunkin’ Donuts Franchisees, and not Dunkin’ Brands, Inc. or any of its affiliates. If hired the Franchisee
will be my only employer. Franchisees are independent business people who set their own wage and benefit programs that can vary among Franchisees.
APPLICANT’S SIGNATURE DATE SIGNED
FA 0509
