Harold's Chicken Shack 45 | The Fried Chicken King

Online Application for Employment Fill out this form, click Send Now and your information will be sent via Email to Harold’s.
Company policy and federal and state law prohibit discrimination due to sex, race, color, gender, religion, national origin/ancestry, citizenship, age, physical or mental disability, medical condition, marital status, sexual orientation, gender identification/orientation, disabled veteran status, Vietnam-era veteran status, or any other characteristic protected by federal or state law.
Answer all application questions to the best of your knowledge. Omission or falsification will result in refusal to hire or termination should you become employed.

Your E-mail Address:
Position Applying for:	Location/Division:
PERSONAL INFORMATION
NAME: (last, first, middle)	Social Security Number:
Have you ever used another name? If so, please list:
PRESENT ADDRESS
Number and Street:	City
State Zip Code	Home Phone (Area Code first):
Cell Phone (Area Code first):	Business Phone (Area Code first):
May we contact you at your work number? Yes No
Have you lived in any other counties in the last 7 years? If so, please list:
Are you at least 18 years of age Yes No
If under 18, can you submit a work permit? Yes No
If applying for a job requiring driving, do you have a valid Drivers' License? Yes No
Do you have the legal right to work in the United States? Yes No (Acceptance is contingent on proof of legal right to work in U.S.)
Have you ever been convicted of a crime other than (1) a marijuana-related conviction that occurred more than two years ago; and (2) an offense for which you were referred to, and participated in, any pre-trial or post-trial diversion program? Yes No
Note: This Company will not deny employment to any applicant solely because the person has been convicted of a criminal offense. This Company, however, may consider the nature, date and circumstances of the offense, as well as whether the offense is relevant to duties of the position applied for.
Are you currently under arrest or released on bond or on your own recognizance, pending trial for a criminal offense? Yes No
AVAILABILITY
I am available to work: Full Time without restriction Part Time Temporary Internship Day Night
Date to begin work:	Desired Salary/Wages:
EMPLOYMENT HISTORY
Please list your most current dates of employment first.
Date of Employment: From To
Company Name and City/State:
Supervisor: Salary:
Position Held:
Reason for Leaving:

Date of Employment: From To
Company Name and City/State:
Supervisor: Salary:
Position Held:
Reason for Leaving:

Date of Employment: From To
Company Name and City/State:
Supervisor: Salary:
Position Held:
Reason for Leaving:

May we contact the employers listed above? Yes No
If not, please indicate which one(s) you do not wish us to contact:
Please identify and explain all periods of unemployment, other than approved Leaves of Absence in the last 5 years.

EDUCATIONAL RECORD
*Last* *High School*:
Full Name of School:	City & State:
# of Years Attended:	Did you graduate? Yes No
Type of Degree and Major:

*Junior College:*
Full Name of School:	City & State:
# of Years Attended:	Did you graduate? Yes No
Type of Degree and Major:

*College or University:*
Full Name of School:	City & State:
# of Years Attended:	Did you graduate? Yes No
Type of Degree and Major:

*Graduate* *School*:
Full Name of School:	City & State:
# of Years Attended:	Did you graduate? Yes No
Type of Degree and Major:

*Trade School:*
Full Name of School:	City & State:
# of Years Attended:	Did you graduate? Yes No
Type of Degree and Major:

REFERENCES
Name:	Relationship:
Employer:	Position:
Address & Telephone:

Name:	Relationship:
Employer:	Position:
Address & Telephone:

Name:	Relationship:
Employer:	Position:
Address & Telephone:

Do you have any relatives employed by the company or its subsidiaries? Yes No If "Yes", give details:
Name:	Relationship:
Facility:	Position:
How were you referred to this company? Internet/Job Board Newspaper Employee Agency School Other
Give names of each checked:
Have you ever worked for this company or any of its subsidiaries? Yes No If "Yes", give details:
Facility: Date: Position:
PLEASE READ CAREFULLY AND SIGN BELOW:
I certify that the information contained in this application is correct to the best of my knowledge. I understand that falsification of this information or material omission may result in the refusal to hire or the termination of my employment at any time. I give the Company the right to make a thorough investigation of my past employment, education, financial background, and activities. I release all persons or entities from all liability for any damage that may result from furnishing information to the Company. I also release the Company and all of its employees from all liability for any damage that may result from the Company’s reliance on the information furnished. My employment with the Company may be contingent upon my successful completion of a post-offer medical examination which includes a blood, urine and/or other medical test for alcohol, drugs and controlled substances. Prior to testing, I agree to sign the Company’s authorization forms wherein I will agree to submit to such testing and to authorize the release of the results to the Company. The physical examination and substance test will be conducted at the Company’s expense by a health care provider selected by the Company. In consideration of my employment, I agree to conform to the Company’s policies, rules and regulations. I understand and agree that my employment is at-will, and therefore, my employment and compensation can terminate, with or without cause, and with or without notice, at any time, at my option or the Company’s option. I further understand and agree that this at-will employment relationship as defined above will remain in effect throughout my employment with the Company, or any of its parent or affiliated companies, unless it is modified by a specific, express written employment contract which is signed by the President of the Company and me. This represents an integrated policy with respect to the at-will nature of the employment relationship.
I hereby agree to the above statement.
Date of Application:
This application is valid for 60 days from this date. If you wish to be considered for employment subsequent to this date, a new application must be completed.

525 Lincoln Highway, Fairview Heights IL, 62208
Tel: (618) 624-9292 Fax: (618) 624-9299
Call In and Fax Orders are Welcome!