Additionally, paste this code immediately after the opening tag:
Employment Application
Equal Opportunity

The Dirty Buffalo is an Equal Opportunity Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Complete the entire application. Please fill out each box (don’t just indicate “See Resume.”) Applications with missing or invalid information will not be considered for any position.

First Name:
Last Name:
Phone Number:
Email Address:
Other names under which you have attended school or been employed:
Street Address:
City, State & Zip:
Are you 18 years of age or older?
Eligible to work in the United States?
Type of Duty:
Are you currently employed?
If YES, name of current employer / position
Start Date:
Have you ever been convicted of a crime other than minor traffic violations? Applicants need not list criminal convictions that have been sealed or expunged by a Court. Convictions will not necessarily disqualify an applicant and will be considered in relation to employment sought
If YES, please explain
Available Start Date:
Full Time and/or Part Time?
Desired Wage:
What days/hours are you available to work? Please indicate hours available for each day or put "any" or "not available."

Education

Level of Education:
Name of school, city & state, graduation date or years left until graduation, degree received, degree major6:
NOTE: Employees of The Dirty Buffalo may be required to obtain a Food Handler's Certificate from the Health Department of the City of Norfolk.

U.S. Military

Branch of Service:
Start Date:
End Date:
Type of Duty:
Specialized Training? If any.

WORK EXPERIENCE

Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. PLEASE DO NOT complete this information with the notation "See Resume." PLEASE NOTE: The Dirty Buffalo reserves the right to contact all current and former employers for reference information.
Past or Last Employer:
Company Phone Number:
Start Date:
End Date:
Name and title of immediate supervisor:
Last position you held and salary:
Reason for leaving:
Past or Last Employer:
Company Phone Number:
Start Date:
End Date:
Name and title of immediate supervisor:
Last position you held and salary:
Reason for leaving:

REFERENCES

Give name of three persons you are not related to and by whom you have not been employed or to whom you have provided services. These people should have known you for several years.
Name:
Address, City, State, Zip
Phone Number:
Occupation:
Years of Acquaintance:
Relation to Person:
Name:
Address, City, State, Zip
Phone Number:
Occupation:
Years of Acquaintance:
Relation to Person:
Name:
Address, City, State, Zip
Phone Number:
Occupation:
Years of Acquaintance:
Relation to Person:
Applicant Certification: Please Read Each Statement Below Closely. By submitting this application you certify, agree, and understand each of the following:

Investigation Authorization: I hereby certify that all entries on all pages and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture of employment on my part. I understand that all information on this application is subject to verification, and I give consent to the Company to perform or obtain criminal history/background checks. I also give my consent for the Company and/or its background checking service to contact references, former employers and educational institutions regarding this application. I further authorize the Company to rely upon and use, as it sees fit, any information received from such contacts. I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.
At-Will Employment: I understand and agree that if I am employed, my employment will be "at-will", which means that the Company may terminate the employment relationship at any time, with or without cause.

Drug and Alcohol Testing Consent: I understand that the Company may require drug and alcohol testing prior to or during my employment. I hereby consent to this testing at a licensed facility of the Company's choosing, and I give permission for test results to be released to the Company. I understand that positive test results, refusal to be tested, or any attempt to affect the test results or test sample may result in withdrawal of my application for employment, withdrawal of any provisional employment offer I have received, or termination of employment, depending on when results are received.