APPLICATION FOR EMPLOYMENT
 

We appreciate your interest in employment opportunities with Doctor's Associates Inc.or one of its affiliates (the SUBWAYAE Group). The SUBWAYAE Group cannot consider you an applicant for employment until you have fully completed an application for a specific position. Therefore, please take a few moments to carefully review and complete the following form so we can begin your application process.

 

 

     
 

Application Form

     
 

IN ORDER THAT YOUR APPLICATION MAY BE PROPERLY ALUATED, IT IS ESSENTIAL THAT ALL OF THE QUESTIONS ON THIS APPLICATION AND ITS ATTACHMENTS BE ANSWERED CAREFULLY AND COMPLETELY. FIELDS IN BLUE ARE REQUIRED FIELDS AND MUST BE COMPLETED BEFORE SUBMITTING FORM.

 

PERSONAL DATA

Last Name*
First Name*
Middle Initial
Present Address*
 
City*
State* (Use 2 Letter Abbreviation)
Postal Code*
Email
Telephone Number* (With Area code)
If hired, can you furnish proof of age?* Yes  No

Are you legally able to be employed in the country(ies) for which you will be working?* Yes No

Have you ever been employed by any member of the SUBWAYAE Group?*   Yes No

If yes,list dates: (Enter dates:mm/dd/yyyy)

How were you referred to the SUBWAYAE Group?*

When are you available for employment?* (Enterdate:mm/dd/yyyy)

        

 EDUCATION

     

Type of School

 

 

High/Trade School

Name & Location of School

Years Attended

Graduated

Yes
No

Name

Fields of Study

Extra Curricular Activities

Bus./Tech.School

Name &Location of School

Years Attended

Graduated

Yes
No

Name

Fields of Study

Extra Curricular Activities

College/University

Name &Location of School

Years Attended

Graduated

Yes
No

Name

Fields of Study

Extra Curricular Activities

ADVANCED EDUCATION

College/University

Name &Location of School

Years Attended

Graduated

Yes
No

Name

Fields of Study

Extra Curricular Activities

 

OTHER TRAINING(Explain)
 

 

     
    
     

Employment Information
 

EMPLOYMENT INFORMATION - (Give particulars of all previous employment, starting with most recent position).

Position Desired*

May we contact your present employer?* Yes No

Wage Desired*(base)

   

1st Company Name

Employment Dates (mm/dd/yy)

From To

Address

Wage History (Round to nearest whole dollar amount).

Starting Ending

City, State, Zip

Supervisor's Name

Job title

Duties (Please be brief).

Reason for termination

2nd Company Name (If applicable)

Employment Dates (mm/dd/yy)

From To

Address

Wage History  (Round to nearest whole dollar amount).

Starting Ending

City, State,Zip

Supervisor's Name

Job title

Duties (Please be brief).

Reason for termination

3rd Company Name (If applicable)

Employment Dates (mm/dd/yy)

From To

Address

Wage History (Round to nearest whole dollar amount).

Starting Ending

City, State,Zip

Supervisor's Name

Job title

Duties (Please be brief).

Reason for termination

OTHER EXPERIENCES
Describe any other experience, skills, abilities or hobbies.

  

I UNDERSTAND THAT

  1. The issuance of this application for employment does not indicate there are any positions open and does not in any way obligate the SUBWAYAE Group.
  2. I will not be paid for time spent while applying for a position or any other processing prior to the beginning of employment.
  3. I understand that I will not be approved for employment if I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities, as defined by the USA PATRIOT Act.
  4. I authorize the release of information and indemnify from liability any claims relating to this release including reliance on the information by the SUBWAYAE Group and all third parties.
  5. I understand that the information I am supplying and the authorization for the release of information will be used only in the pursuit of employment opportunities with the SUBWAYAE Group. Otherwise, the information will be kept confidential, except as required to be disclosed under the USA PATRIOT Act or other applicable laws.
  6. If hired, I am on a ninety (90) day trial period and am an <<at will>> employee, except if I sign an Employment Contract in which case the terms of the Employment Contract will govern.
  7. If required to sign a contract as part of my employment, I will do so and will sign any subsequent changes and renewals as necessary.
  8. Any misrepresentation or omission of facts or any false or misleading information on my application, resume, or during the interview may result in the refusal of employment or,if employed, may result in immediate dismissal.
  9. I understand and agree to maintain the confidentiality of confidential information, trade secrets and proprietary information of the SUBWAYAE Group and its vendors.
  10. In accepting employment with the SUBWAYAE Group, I agree to abide by all company rules and regulations which are in effect or may be established in the future.
  11. The SUBWAY AE Group is an Affirmative Action Equal opportunity Employer and encourages the hiring and promotion of all protected classes.

I DECLARE MY ANSWERS TO THE QUESTIONS ON THIS APPLICATION AND ATTACHMENTS TO BE TRUE, FURTHERMORE, I GIVE THE SUBWAY GROUP THE RIGHT TO THOROUGHLY INVESTIGATE MY BACKGROUND, INCLUDING BUT NOT LIMITED TO: ACADEMICS, EMPLOYMENT RECORD, INCLUDING SALARY, AND OTHER MATTERS RELATED TO MY SUITABILITY FOR EMPLOYMENT.

 

  

  

Date* (example:04/30/2001)

Signature* (type name in this field)

I have read this disclaimer.*

     
    
     
 

ADDENDUM TO APPLICATION FOR EMPLOYMENT
(Revised 05/04)

 

Have you ever been convicted of a felony?* (check one of the following):
Yes, per the definition(s) provided below, I have been convicted of a felony (defined as a crime that could have over one (1) year's jail time)
No, per the definition(s) provided below, I have never been convicted of a felony (defined as a crime that could have over one (1) year's jail time)
 

Have you ever been suspected of engaging in terrorist activities?* (check one of the following):
Yes, I have been a suspected terrorist or associated directly or indirectly with terrorist activities (as defined by the USA PATRIOT Act)
No, I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities (as defined by the USA PATRIOT Act)
 

I understand that:

  • I am not required to disclose the existence of any arrest, criminal charge or conviction, the records of which have been rased pursuant to section 46b-146, 54-76o or 54-142a.Criminal records subject to erasure pursuant to section 46b-146, 54-76o or 54-142a are:
  • Records pertaining to a finding of delinquency or that a child was a member of a family with service needs
  • an adjudication as a youthful offender
  • a criminal charge that has been dismissed or nolled
  • a criminal charge for which the person received an absolute pardon
  • Any person whose criminal records have been erased pursuant to section 46b-146, 54-76o or 54-142a shall be deemed to have never been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear my oath.
  • A complete and thorough background check may be conducted by the SUBWAY Group.
  • I authorize the procurement of an investigative consumer report and background search in accordance with anti terrorism legislation such as the USA PATRIOT ACT and Executive Order 13224 enacted by the US Government. I understand at this investigation may reveal information about my background, character, general reputation, mode of living, association with other individuals or entities, credit worthiness and job performance.
  • The above information is voluntarily provided by me.
  • I declare the information provided above is true and give the SUBWAYAE Group the right to investigate and secure additional information as needed

 

  

 

Date* (example: 04/30/2001)

Signature* (type name in this field)

I have read this disclaimer.*