Platinum Corral Careers

APPLICATION FORM
Fill out the application form below. All fields are important, unless specified otherwise. Please fill out as many as possible. When you are done, click "Continue to Step 2" at the bottom of the page.

CONTACT INFORMATION
First Name	Middle Initial
Last Name
Social Security No.
Street Address
City, State, Zip
Home Phone
Cell Phone
Email

IN CASE OF EMERGENCY, NOTIFY:
Name
Relationship
Phone

RESTRICTIONS
If you are currently restricted from performing any of the essential elements of a management position, please explain below the nature of the restriction and any reasonable accommodation which might enable you to perform these essential job duties. If none, leave this part blank.

Are you a U.S. Citizen or otherwise authorized to work in the United States?
Yes No

Have you ever been employed by Golden Corral Corp. or any of its franchisees?
Yes No

Dates: Location: Position:

Have you ever been convicted* of, pled no contest to or are you now subject to a charge of any felony, or a misdemeanor involving violence or sexual assault?
Yes No

*Conviction will not necessarily disqualify you from employment; please explain:

EMPLOYMENT EXPERIENCE
Beginning with the most recent, fill in the blanks below with the reqested information about your recent employers. Be sure to fill in all gaps of time.

(Example: Platinum Corral, Asheboro, Kitchen Manager, John Doe 336-123-4567, 12/1/07-9/16/09, $65,000)

Employer, City, Title, Supervisor Name & Phone, Start Date, End Date, End Income

EDUCATION
List last school attended, and whether graduated or not.

School/College/Univ. Name & Location:

Attended from to

Course of Study

Graduate? Yes No

DRIVER'S LICENSE
License Number
State
D.O.B.

TERMS & CONDITIONS

1. I certify that the above is true and correct. I authorize Platinum Corral, LLC (PC,LLC) to verify this information as necessary and release PC,LLC with respect to this verification, I authorize and release each person from liability who provides such information. Employment will at all times be subject to the policies and procedures of PC,LLC, which may be changed from time to time. Employment may be terminated at any time by me or PC,LLC with or without cause.

NOTICE: DRUG AND ALCOHOL TESTING
2. I understand and consent that as a condition of employment with the PC,LLC I may be required to submit a sample of urine, blood or hair for chemical analysis at a certified laboratory to check for the presence of alcohol or illegal drugs in my system. I hereby release PC,LLC from any liability arising from this request and give my permission for any certified laboratory to release the results of these tests to PC,LLC and consent that all pertinant parties may make such disclosures of the test results to its agents or third parties as PC,LLC may deem appropriate. I further understand that my employment is conditioned on my willingness to submit to pre-employment, random or post-accident testing for the presence of alcohol or illegal substances in my system and may result in termination of my employment and denial of worker's compensation benefits.

RELEASE AND AUTHORIZATION FOR CONSUMER REPORTS
3. In connection with, and as part of, my application for employment, or at anytime during my employment I understand investigative reports may be conducted. These reports can include consumer credit, criminal records, driving records, Social Security earnings records and past employment records for experience and cause for termination. Such consumer reports may contain public record information from various government agencies and may contain personal interviews regarding my character, general reputation, personal characteristics, or mode of living through contact with former employers, neighbors, friends and associates.

I hereby authorize, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I understand that I have the right to make a request of the reporting agency, upon proper identification and payment of authorized fees, a copy of said report.

BY TYPING MY INITIALS IN THIS BLANK, I AGREE THAT I HAVE READ AND UNDERSTAND AND AGREE TO BE BOUND BY THE TERMS AND CONDITIONS ABOVE.

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