OCAT, Incorporated

Personal Information

* = Indicates optional field

First name:

Middle Name:

Last Name:

OTHER NAME(S) YOU HAVE USED AT WORK OR SCHOOL: *

Phone Number:

Street Address:

City:

State:

ZIP code:

How long (in months) have you lived at your current address?

Person to Contact in Emergency (include phone number):

Are you under the age of 18? Yes No

If "yes," can you, after employment, show proof of age? Yes No

Have you ever been counseled or disciplined for being late or absent from work or school? Yes No

The U.S. Secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia, and compylobacter, may prevent you from serving food or handling food equipment in a sanitary or healthy fashion. An essential function of this job involves serving food or handling food equipment in a sanitary and healthy fashion. Can you, with or without reasonable accommodation, perform this essential function of this job? Yes No

Have you ever been convicted of a felony, a crime involving dishonesty, or a crime involving violence to another person?* Yes No

If yes, please describe, including dates charged, penalties, and current disposition. Note: Convictions are not an automatic disqualification from employment.*

* Residents of Maryland, Massachusetts, and Washington State, read the information about this question on the back page.

Position Requested

Team Member: No experience required *

Shift Lead: Food service or retail experience required *

Assistant Manager/Restaurant General Manager: Management experience required *

Availability

Monday
From To

Tuesday
From To

Wednesday
From To

Thursday
From To

Friday
From To

Saturday
From To

Sunday
From To

Do you have reliable transportation to get to work? Yes No

Would you be willing to work at another Taco Bell store? Yes No

If hired when could you begin work? (Month/Day/Year)

How many hours would you like to work each week?

Education

High School

Name:

City:

State:

Number of years completed:

GPA:

Degree or Diploma:

Contact Person Department / Phone:

College

Name: *

City: *

State: *

Number of years completed: *

GPA: *

Degree or Diploma: *

Contact Person Department / Phone: *

Other

Name: *

City: *

State: *

Number of years completed: *

GPA: *

Degree or Diploma: *

Contact Person Department / Phone: *

Please list all job-related organizations, clubs, or activities you are/were involved in at school, except those that indicate race, religion, color, national origin, ancestry, sex, or age.
*

Work Experience

Company 1

Company:

Address:

Position and Duties:

Supervisor Name & Phone:

May we contact? Yes No

Dates Employed

From:

To:

Reason for Leaving:

Ending Wage, $/hour:

Company 2

Company:

Address:

Position and Duties:

Supervisor Name & Phone:

Dates Employed

From:

To:

Reason for Leaving:

Ending Wage, $/hour:

Company 3

Company:

Address:

Position and Duties:

Supervisor Name & Phone:

Dates Employed

From:

To:

Reason for Leaving:

Ending Wage, $/hour:

Have you or any of your relatives ever worked for Taco Bell Corp., Pizza Hut, Inc., KFC Corporation, Tricon Global Restaurants, Inc. or any franchisee of these companies?

*Residents of Kansas: Include only yourself, spouses, or children.

Relationship: * *

Company: *

Location (City/State): *

Dates Employed:

From: *

To: *

References

Reference 1

Name:

Phone Number:

How long have you known this person (in years)?

Relationship to you :

Type of reference: School Work Personal

Reference 2

Name:

Phone Number:

How long have you known this person (in years)?

Relationship to you:

Type of reference: School: Work Personal

Reference 3

Name:

Phone Number:

How long have you known this person (in years)?

Relationship to you:

Type of reference: School Work Personal

Applicant's Statements

READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE COMPLETING THIS APPLICATION. ONLY APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID.

The information I am presenting in this application is complete, true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omissions could result in the denial of my application, withdrawal of any offer of employment, or immediate discharge.

I understand that in connection with the application process, Taco Bell and its representatives may contact my former employers, educational institutions, references, and other relevant third parties to obtain additional information related to the information given by me in this application. I also understand that Taco Bell may provide such information to its parent company and affiliates and to other third parties. I hereby request, release, and consent to the release and disclosure of such information. I further release and hold harmless Taco Bell, Taco Bell's parent company and affiliates, their officers, employees and agents, and any other parties inquiring about, investigating, furnishing, communicating, reviewing, or evaluating such information from any and all potential claims, demands, damages, liabilities, and/or actions of any kind arising from such activities, whether known or unknown to me presently, that I may have, now or in the future.

If employed, I agree to conform to the rules and regulations of Taco Bell Corp. and understand that I will be an employee at-will, and my employment may be terminated at any time by me or Taco Bell, with or without notice, for any reason. I understand that only the President of Taco Bell Corp. or the Vice President of Human Resources of Taco Bell Corp. has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.