Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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When are you available to begin work? *

MM

DD

YYYY

Phone *

(###)

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Start Date *

MM

DD

YYYY

End Date *

MM

DD

YYYY

Phone *

(###)

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Start Date *

MM

DD

YYYY

End Date *

MM

DD

YYYY

Reference Phone *

(###)

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1. The information that I have provided on this application is accurate to the best of my knowledge and may be verified by Clay's Restaurant or its agents. *

YES

NO

2. I authorize all the schools, persons and organizations named in this application to provide any relevant information in their possession or knowledge to the agents of Clay's Restaurant, for use in deciding whether or not to offer me employment and specifically waive any required written notification. I hereby release Clay's Restaurant, my former employers and all other persons from any and all claims, demands, or liabilities arising out of or in any way related to such inquiry or disclosure. *

YES

NO

3. I understand that Clay's Restaurant is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if the Clay's Restaurant has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination. *

YES

NO

4. I understand and agree that any misrepresentation or omission of facts in this application will be justification for refusal or termination of employment, regardless of the time elapsed before discovery. *

YES

NO

5. I understand and agree that the employment for which I am applying for is at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or Clay's Restaurant. There will be no agreement, express or implied between Clay's Restaurant and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by an authorized representative of Clay's Restaurant. *

YES

NO

6. I have placed my signature in the space provided below only after I have completed the entire application to the best of my ability and have carefully read the statements above. *

YES

NO

Applicant Name *

This will serve as a digital signature for this application.

First Name

Last Name

Date of form submission. *

MM

DD

YYYY