Employment Application

First Name*
Last Name*
Address*
City*
State*
Zip Code*
Phone*
Email*

Are you 18 years or older?*
- Yes
- No
Have you been convicted of a felony within the last seven (7) years?*
- Yes
- No
(Conviction will not necessarily disqualify an applicant from employment.)
If yes, please explain:
Are you a US citizen or authorized by the INS to work in the United States?*
- Yes
- No

Employment
Upload a Resume?*
- Yes
- No - I will enter my employment information manually.
Upload resume:

Current Employer - Company Name and Address*
Supervisor Name, Title and Phone #*
Describe in detail work you did and your title:
Start Hourly Wage
End Hourly Wage
Can we contact your current employer?*
- Yes
- No
Add Another Employer?*
- Yes
- No

Previous Employer: Company Name and Address
Supervisor Name, Title and Phone #
From:
To:
Describe in detail work you did and your title:
Reason for Leaving:
Add Another Employer?*
- Yes
- No

Previous Employer 2: Company Name and Address
Supervisor Name, Title and Phone #
From:
To:
Describe in detail work you did and your title:
Reason for Leaving:

I hereby give The Mid American Grille permission to contact my former employers and be provided with complete information regarding my former employment including any and all information included in my personnel file and/or reasons for the end of my employment.*
- Agree

Education
High School Name and Address*
Diploma/Degree*
College / Trade School Name and Address
Diploma/Degree

Personal Reference #1
Name
Relationship
Company
Phone #
Personal Reference #2
Name
Relationship
Company
Phone #

APPLICANT'S STATEMENT AND CONDITIONS OF EMPLOYMENT

I certify that the answers given by me in this employment application are true, correct and complete. I agree that The Mid American Grille shall not be liable, in any respect, if my employment is terminated because of misstatements or pertinent omissions made by me in this application. Further, I agree that if I seek damages for my termination and it is determined that, in any respect, that my employment was terminated and/or would have been terminated because of misstatements or pertinent omissions made by me in this application or failure to follow The Mid American Grille's rules or regulations, that I will be responsible for any and all actual attorney fees and costs incurred by The Mid American Grille in defending itself.

I agree to the search or examination of myself or personal property while on The Mid American Grille premises. I also authorize any company, school, police or security personnel, or other person to give any information regarding my employment, habits, ability, or any other characteristics whatsoever, together with any information they have regarding me whether or not it is in their records, to The Mid American Grille. I hereby release all companies, schools, or other persons from liability for any damages whatsoever for releasing this information. The use of results from this form and/or tests will be used for prudent employment decisions. It is agreed and understood that completion of this application does not mean a job opening exists and in no way obligates The Mid American Grille to employ me.

In the event of employment, I will comply with all of The Mid American Grille's rules and regulations as established from time to time. I also understand that The Mid American Grille retains the right to amend, modify, add or delete any or all policies or procedures at its sole and absolute discretion.

I hereby understand and acknowledge that any employment relationship with THe Mid American Grille is of an “At-Will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time, with or without notice, with or without cause. It is further understood that this “At-Will” employment relationship may not be changed by any written document or by verbal agreement unless such change is specifically acknowledged in writing by an authorized Executive of The Mid American Grille.

During my employment with The Mid American Grille and after my employment ends, I agree not to disclose any confidential or proprietary information regarding operating and trade secrets. I further agree that with respect to any civil litigation involving The Mid American Grille in which I am a potential witness and which does not involve an actual or potential claim by me personally, I will not discuss the facts of the case with any third parties without first notifying The Mid American Grille or unless an authorized Executive or attorney of The Mid American Grille is present. I agree that any such discussions in violation of this agreement will cause irreparable harm to The Mid American Grille. A copy of this form may be used as the original. I agree that any claim or lawsuit relating to my service with The Mid American Grille or any of its subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

This application is valid for sixty days from the application date unless renewed in person or in writing.
Electronic Signature:*
Please Type Your Name
Date*
Phone
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