Online Employment Application - Tacoma, Inc.
PLEASE TELL US ABOUT YOURSELF
Last Name   First Name   Middle Initial   Preferred Name  
Current Address   City   State   Zip   Years There  
Most Recent Previous Address   City   State   Zip   Years There
Telephone (Home)   Telephone (Cell) or Pager   Are You 16 or Older? Yes No
Email Address
WHAT WOULD YOU LIKE TO DO AT TACO BELL?
Team Member   Shift Supervisor   Assistant Unit Manager   Restaurant General Manager   Other:
Part Time  Full Time     Desired Wage/Salary: $   Per Hour Annually
City or cities where you can work (check all that apply):
Bedford  Blacksburg  Christiansburg  Collinsville  Danville  Dublin  Farmville  Forest 
Lynchburg  Martinsville  Radford  Roanoke  Salem  South Boston  Troutville  Vinton 
How did you find out about TACO BELL?
Availability * Mon Tues Wed Thurs Fri Sat Sun
From
To
 
* If your religious beliefs or practices prohibit you from working on a particular day or at a particular time, TACO BELL will make reasonable efforts to accomodate those beliefs or practices in accordance with applicable law.
WHAT SCHOOLS HAVE YOU ATTENDED?
  Name City State From To Diploma/Degree
High School:
 
 
College:
Other:
TWO MOST RECENT JOBS
Company and Address    May we contact? Yes No
Telephone    Supervisor's Name    Dates Worked
What did you do?    Last Salary $ Per Hour Annually
Why did you leave?
Company and Address    May we contact? Yes No
Telephone    Supervisor's Name    Dates Worked
What did you do?    Last Salary $ Per Hour Annually
Why did you leave?
MISCELLANEOUS INFORMATION
Do you have reliable transportation to get to work? Yes No If hired, when you could you begin work?
If hired, can you show proof of your legal right to work in the United States?  Yes No
If you have worked for any our affiliated companies (listed below) or one if their Franchisees or Licensees or previously applied for employment, please check the appropriate boxes and then provide the Information requested below.
Yum Restaurant Services Group   KFC   Pizza Hut   Taco Bell   Long John Silver's   A&W   Franchisee/Licensee
Company and Address
Telephone    Supervisor's Name    Dates Worked
What did you do?    Last Salary $ Per Hour Annually
Why did you leave?
REFERENCES: List two school, work or personal references we may contact. Do not list family members
Name Relationship to You How Long Have You
Known This Person?		 Type of
Reference		 Telephone
OTHER INFORMATION ABOUT YOURSELF
1. Within the last 7 years, have you been convicted of, or completed your sentence or parole for a crime including violence, sex, stalking, minors, theft, property damage, fraud, robbery or drugs? * Yes No
2. Are you currently charged with a crime involving violence, sex, stalking, minors, theft, property damage, fraud, robbery or drugs? ** Yes No
* Crimes include felonies, misdemeanors, and other violations of the law. However, you should not respond "Yes" as a result of any conviction that has been judicially settled, expunged or pardoned. Conviction of a crime will not necessarily disquality you from consideration for employment and will be considered only as it relates to the job in question. CALIFORNIA residents do not respond "Yes" for (i) conviction records that have been sealed or expunged by court order or statutorily eradicated; (ii) misdemeanor convictions for which yuo have successfully completed or otherwise discharged probation; (iii) misdemeanor marjuana convictions if the conviction occurred more than two years ago; (iv) any past arrest or detention not resulting in a conviction; or (v) any referral to or participation in any pretrial or post trial diversion program. HAWAII residents, do not answer this question. LOUISIANA residents, do not respond "Yes" as a result of a misdemeanor. MASSACHUSETTS residents, do not respond "Yes" as a result of any misdemeanor conviction where the date of the conviction or the completion of incarceration, whichever date is later, occured more than five years ago. PENNSYLVANIA residents, do not respond "Yes" as a result of a summary offense.
** Residents of HAWAII, LOUISIANA, MASSACHUSETTS, NEVADA, PENNSYLVANIA, RHODE ISLAND or UTAH, do not answer this question. Residents of MICHIGAN, do not answer "Yes" as a result of pending misdemeanor charges.
AGREEMENT: Please read below:
Nature of My Employment - If I am hired by TACO BELL, I agree that I will be an at-will employee, which means that either I or TACO BELL may end my employment at any time, with or without cause or notice. I agree that no written materials or verbal statements by TACO BELL will constitute an expressed or implied contract of continued employment and that this at-will relationship can only be modified in writing by TACO BELL's President. I agree that, if hired, I will obey TACO BELL's rules, including treating confidentially any information I learn during my employment.
My Participation in TACO BELL's Drug Free Environment - I am not a current user of illegal drugs and I agree I will never work under the influence of drugs or alcohol.
My Records and References - There is nothing in my background that would cause a risk to TACO BELL's customers, employhees, or property. I authorized TACO BELL to conduct reference checks, criminal and driving records checks, and other consumer report investigations. I release all parties from any liability from providing such information to TACO BELL. In this regard, I understand that conviction of a crime will not necessarily disqualify me from consideration for employment. I understand that the nature and date of the offense and the relevance of the offense to the position(s) applied for will determine my eligility for employment.
Information Certification - I certify that the information I have provided to TACO BELL is true and complete. I agree to notify TACO BELL immediately if I am later charged with any of the crimes listed above or (if I am a delivery driver) with a driving offense. I agree that any false information or omissoin allows TACO BELL to refuse to hire me, or to terminate my employment at any time.
Atrement to Arbitrate - Because of the delay and expense of court systems, TACO BELL and I agree to use confidential binding arbitration, instead of going to court, for any claims that arise between me and TACO BELL, its related companies, and/or their current or former employees. Without limitation, such claims would include any concerning compensation, employment (including, but not limited to, any claims concerning sexual harassment or discrimination), or termination of employment. Before arbitration, I agree: (i) first to present any such claims in full written detail to TACO BELL, (ii)next, to complete any TACO BELL internal review process, and (iii) finally, to complete any external administrative remedy (such aswith the Equal Employment Opportunity Commission). In any arbitration, the then prevailing employment dispute resolution rules of the American Arbitration Association will apply, except that TACO BELL will pay the arbitrator's fees, and TACO BELL will pay that portion of the arbitration filing fee in excell of the similar court filing fee had I gone to court.
Applicant's Signature    Date   
Information for Maryland and Massachusetts Residents - Under Maryland and Massachusetts law, an employer may not require or demand as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is subject to penalty.
Information for Connecticut Residents - You are not requried to disclose the existence of any arrest, criminal charge or conviction, the records of which have been erased pursuant to section 46b-146, 54-76o or 54-142. If your only criminal record consists of items that have been erased under the statutes listed above, then you may state on this form that you have not been arrested.