* What position or positions are you applying for?:

* What is the date of this application?:

* How did you learn about us?:

Current Employee Friend Relative Walkin Newspaper Employment Agency Social Media Facebook Snag Instagram Craigslist Linked In Flyer

If none of the above apply, please describe below how you learned about us.:

* Primary phone number:

Secondary phone number:

Other phone number:

* Social Security Number:

* Are you 18 years of age or older?:

Yes   No

* If you are under 18 years of age, can you provide required proof of eligibility to work?:

Yes   No

* Are you currently employed?:

Yes   No

May we contact your present employer?:

Yes   No

* Have you ever filed an application with us before?:

Yes   No

If yes please give date of previous application:

* If hired, can you show proof of identity and legal authorization to work in the United States?:

Yes   No

* On what date will you be available for work:

* Are you available to work?:

Full Time   Part Time   Temporary

* Are you currently on 'lay-off' status and subject to recall?:

Yes   No

If presently employed, why do you desire to change your position?:

* Have you been convicted of a criminal offense within the last 7 years?:

Yes   No

(Conviction will not necessarily disqualify an applicant from employment.)

Give your full employment record, starting with your current or most recent employment

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
	Yes   No
	Yes   No
	Yes   No
	Yes   No
	Yes   No

Name	Relationship	Phone Number

Name	Address	Phone #

I certify that answers given herein are true and complete to the best of my knowledge. I understand that falsification, omission or misstatement of information may result in refusal to hire or, if hired, termination of employment. I hereby give permission to Highland Corporation and any third party it so chooses to utilize, to conduct a personal check on my background, including but not limited to, work history, business and personal record and/or references, credit history, or criminal investigation, and hold harmless the above referenced. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications am being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the organization is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge employee at my time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I understand, also, that I am required to abide by all rules and regulations of the employer.

* Type full name:

* Date:

The Fair Credit Reporting Act (FCRA) provides individuals with certain rights regarding consumer reports and places certain obligations on employers using consumer reports for employment-related purposes. Consistent with the FCRA's requirements, this notice is provided to you in order to inform you that Highland Corporation may, for employment-related purposes (e.g., evaluating you for initial employment, promotions, transfers, assigned duties, retention as an employee, etc.) obtain from a consumer reporting agency one or more consumer reports containing financial information, criminal record information, driving record information and/or relevant information about you. Highland Corporation will not obtain a consumer report without your signature below authorizing us to obtain one or more consumer reports.


I hereby acknowledge that I have read and understand the contents of the above notice and, by signing below, specifically authorize Highland Corporation to obtain one or more consumer reports on me for employment-related purposes as indicated above.

* Type full name:

* Date:

The Secretary of Health & Human Services has determined that certain diseases, including Hepatitis A, typhoid fever(Salmonella typhi), shigellosis(Shigella spp.), and E coli(Escherichia coli 0157:H7) may prevent you from serving food or handling food equipment in a sanitary or healthy fashion. An essential function of this job involves handling & serving food, food service equipment and utensils in a sanitary and healthy fashion.

* Are you able to perform the essential functions of this job with or without a reasonable accommodation?:

Yes   No

If no, please explain?:

* Are you an employee?:

Yes   No

* Are you a prospective employee?:

Yes   No

* Please enter the state that issued your driver's license:

* Please enter your driver's license number:

* Have you ever been denied a driver's license or had one suspended or revoked?:

Yes   No

* Have you had any violations in the past 3 years?:

Yes   No

* Have you had any auto accidents in the past 3 years?:

Yes   No

* IF THE ANSWER TO ANY QUESTIONS WAS YES, please explain (give dates of violations and/or accidents):

DRIVER- I affirm that the statements made above are stated truthfully and without reservation.

* Type full name:

* Date:

Please list the street address (or PO Box), city, state, zip code, county and length of time resided at all previous addresses for 7 years.

* Current Address:

Former Address:

Former Address:

Former Address:

Other previous addresses:

NOTE: WE NEED ALL ADDRESSES FOR THE PAST SEVEN YEARS.

* Maiden Name/Former Married Name:

* Date of Change:

* Social Security Number:

* Daytime telephone number:

* Driver's license number:

* State of issuance:

* Have you ever been convicted of a crime or convicted in a military court?:

Yes   No

* Have you ever been sanctioned or had your licenses suspended or revoked?:

Yes   No

* Are you currently under any investigation or pending charge?:

Yes   No

This information will enable us to properly identify you in the event we find adverse information during the course of our background search. The Credit Information Center is a division of the Credit Bureau of Nashville, Inc.