Fillable Printable Chili's Application Form
Fillable Printable Chili's Application Form
Chili's Application Form
CONFIDENTIAL PROPERTY OF CORVIRTUS, LLC AND BRINKER INTERNATIONAL PAYROLL COMPANY, L.P.
©2006 CorVirtus, LLC and Brinker International Payroll Company, L.P. REV 10/08
BRINKER INTERNATIONAL PAYROLL COMPANY, L.P.
APPLICATION FOR EMPLOYMENT
In compliance with Federal and State equal employment opportunity laws applicants are considered for
positions without discrimination on the basis of race/color, religion, sex, national origin, citizenship, age,
disability, marital status, veteran/military status, or any other consideration made unlawful by applicable
federal, state, or local law s.
In order for you to be cons idered for employm ent, this applicat ion must be filled out COM PLETELY. Please writ e
“N/A” if information is not applicable. Résumés, though welcome, should not be submitted in place of the
information requested below.
PLEASE PRINT
First Name Middle Initial Last Name
Social Security or Other ID Number
Today’s Date
Current Address: Street/P.O. Box Apt. #
City
State ZIP
Permanent Address: Street/P.O. Box Apt. #
City
State ZIP
Day Phone No. Evening Phone No. Alternate Phone No. ( Pager Cell Other )
( ) ( ) ( )
For which position are you applying? Date you are available for employment
What is the minimum amount of money you expect to make? $ /hour $ /week
1. If hired, can you present evidence that you are legally able to work in the United States?
(Proof of identity and
legal authority to work in the United States is a condition of employment.)
........................................ Yes No
2. If hired, can you submit proof of legal age to work in th is state? ............................................
Yes No
3. Are you of legal age to serve alcohol in this state? ...............................................................
Yes No
4. As an adult, have you been convicted of a felony or pled guilty to a felony resulting in conviction, which
conviction has not been annulled, erased, expunged, vacated, set aside, sealed by the Court, or referred to
a diversion program?
(Applicants in California, Connecticut, District of Columbia, Georgia, Hawaii, Massachusetts, and
Washington should read the information on the last page of this application BEFORE answering this question.)
..................................................................................................................................... Yes No
Conviction will not necessarily disqualify an applicant from employment. Factors such as the age and time of the offense, seriousness
and nature of the violation, rehabilitation, and job-relatedness will be considered when making any employment decisions. If your
answer is “yes,” plea se explain the circums tances surrounding such offense, including place, date, name of court, etc.
5. Have you ever applied for a job with Ch ili’s, Maggiano’s, On The Border, or any other Brinker concept?
.....................................................................................................................................
Yes No
If yes, which location?
What was the result?
6. How many jobs have you held in the last two years? ...................... 0 1 2 3 4 or more
7. Have you ever been terminated from a job? .......................................................................
Yes No
If yes, how many jobs have you been terminated from? .......................... 1 2 3 4 or more
8. You want to work: Part-time (______
hours per week) Full-time (______hours per week)
CONFIDENTIAL PROPERTY OF CORVIRTUS, LLC AND BRINKER INTERNATIONAL PAYROLL COMPANY, L.P.
©2006 CorVirtus, LLC and Brinker International Payroll Company, L.P. REV 10/08
9. Do you presently have a job that you intend to keep? ...........................................................
Yes No
10. In the table below, please indicate the days you CAN work. List the earliest and latest times you CAN
work. Please account for travel time to and from other obligations (e.g., sports, classes, meetings, etc.).
Being on time for a shift is mandatory.
MON TUES WED THURS FRI SAT SUN
Earliest time in
Latest time out
11. Do you have a reliable means of transportation to and from work for the days and times you are available?
.....................................................................................................................................
Yes No
12. Are you available to work holidays and weekends? ...............................................................
Yes No
13. We may conduct training on days, or at times, you have other obligations. Is your schedule flexible so you
may come to training? ......................................................................................................
Yes No
14. Are you, or do you plan to be, in school or taking courses at any time while working here? ........
Yes No
15. If you have other obligations or commitments that may affect your schedule (such as travel plans) please
indicate the particular dates and times that you will be unavailable.
(You may omit any information indicating
legally protected characteristics such as race/color, religion, sex, national origin, citizenship, age, disability, marital
status, or veteran/military status.) _____________________________________________________________
____________________________________________________________________________________
16. Education
Name and Location of
School
Dates Attended
Last Year
Completed
Major/Specialty
Degree
Received
High
School
(Please leave blank.) Grade: 9 10 11 12 (Please leave blank.)
College/
Other
From /
Month Year
To /
Month Year
17. Do you agree not to brin g into any Company facility confidential informat ion of any third parties th at relates
in any way to the restaurant industry, and to keep confidential and not disclose any of the Company’s or any
third parties’ confidential information? ...............................................................................
Yes No
18. Have you read a job description for the position of interest? ..................................................
Yes No
Do you understand the job requirements? .......................................................................... Yes No
19. Can you perform the essential functions required by the job for which you are applying either with or
without reasonable accommodations? ................................................................................
Yes No
20. Personal References (other than immediate family):
Name Phone Number
Number of Years
Known
Relationship
CONFIDENTIAL PROPERTY OF CORVIRTUS, LLC AND BRINKER INTERNATIONAL PAYROLL COMPANY, L.P.
©2006 CorVirtus, LLC and Brinker International Payroll Company, L.P. REV 10/08
21. Work History (List your last 3 jobs.)
Current or Most
Recent Job
Previous Job Previous Job
Company Name
Address
Position
Job Duties
(please describe)
Did you handle cash?
Yes No Yes No Yes No
Name and Title of
Immediate Supervisor
Phone Number of
Immediate Supervisor
Dates of Employment
/ to /
Month Year Month Year
/
to /
Month Year Month Year
/
to /
Month Year Month Year
Usual Number of Hours
Worked per Week
Reason for Leaving
Weekly Earnings
$ $
Starting Ending
$
$
Starting Ending
$
$
Starting Ending
All employers, including
your current employer,
may be contacted to
verify the information
you provide.
May we contact your
current employer prior to
any offer of employment?
Yes No
May we contact this
employer prior to any offer
of employment?
Yes No
May we contact this
employer prior to any offer
of employment?
Yes No
CONFIDENTIAL PROPERTY OF CORVIRTUS, LLC AND BRINKER INTERNATIONAL PAYROLL COMPANY, L.P.
©2006 CorVirtus, LLC and Brinker International Payroll Company, L.P. REV 10/08
Applicants in California, Connecticut, District of Columbia, Georgia, Hawaii, Massachusetts, and Washington should read the
following information BEFORE answer ing questi on 4:
California: Do not identify convictions under California Health & Safety Code §§11357(b) or (c), 11360(b) (formerly subdivision (c) of
section 11360), 11364, 11365, or 11550 related to marijuana offenses that occurred two or more years before the submission of this
employment application.
Connecticut: Applicants are not required 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 54-142a. Criminal records subject to erasure pursuant to section 46b-146, 54-76o or
54-142a are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a
youthful offender, a criminal charge that has been dis missed or nolled, a criminal charge for which the person has been found no t guilty or a
conviction for which the person received an absolute pard on. Any perso n whose cr iminal re cords have been erased p ursuant to section 46b-
146, 54-76o or 54-142a shall be deemed to have never been arrested within the meaning of the general statutes with respect to the
proceedings so erased and may so swear under oath.
District of Columbia: Do not identify a conviction that is more than ten (10) years old at the time of making this application.
Georgia: Do not identify any conviction that is considered a first offender discharge under §42-8-63 of the Georgia Code.
Hawaii: Do not answer this question at this time. You will only have to answer this question if you receive a conditional offer of
employment.
Massachusetts: An applicant for employment with a sealed record on file with the commissioner of probation may answer ‘no record’ with
respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment
may answer ‘no record’ with respect to any inquiry rela tive to prior arrests, cour t appearances and adjudications in al l cases of delinquency
or as a child in need of services which did not result in a c o mplaint transferred to the superior court for criminal prosecution.
Washington: Do not identify a conviction that is more than ten (10) years old at the time of making this application.
NOTICES TO APPLICANTS IN CERTAIN STATES:
Note to Rhode Island applicants:
In Rhode Island, smoking is prohibited in enclosed areas within places of employment.
This Company is subject to Chapters 29-38 of Title 28 of the Genera l Laws of Rhode Island and is therefore covered by the state’s workers’
compensation law.
Note to Massachusetts applicants:
It is unlawful in Massachusetts to requ ire or administer a lie detector test as a condition of employment or continued employment. An
employer who violates this law shall be subject to criminal penalties and civil liability.
Note to Maryland applicants:
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE
EMPLOYMENT, OR CONTI NUED EMPL OYMENT, THAT AN INDIV IDUAL SUBMIT TO OR TAKE A LIE DETECT OR OR SIMILAR TE ST.
AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
_____________________________
Signature of Maryland Applicant
Please Read the Following Carefully and Sign Below
I declare that I am qualified to perform all the duties of the position I am seeking. I also declare that the information provided in this Application is correct and
that any false statements or omissions will justify my rejection for or dismissal from employment. I authorize the Company to conduct any necessary
investigation regarding my background (including inquiries of me, prior or current employers, schools and other persons, institutions, or businesses, and
checking motor vehicle records, court records and criminal records) as it relates to the position I am seeking and to the extent permitted by federal, state, and
local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection
with the provision and use of such information. I will agree to a drug test, if permitted by law, to be paid for by the Company. (The re sults of a ny drug tests
may, consistent with applicable law, be used to make employment decisions, including decisions relating to hiring and continued employment.) I understand
and agree that this Application for employment does not create a contract for employment or a guarantee of employment. I understand and agree that if I am
hired, my employment is “AT-WILL” which means that my employment is for no definite period of time and either the Company or I may terminate the
employment relationship with or without cause at any time, with or without any advance notice. I understand that only the CEO may change the AT-WILL status
of any applicant or employee and may only do so in writing. I understand that any policies or procedures implemented by the Company in the event of my
employment do not alter my AT-WILL employment status. I understand that the Company, in its sole discretion, may at any time change its personnel policies
and may also change my job description, responsibilities, wages, and benefits. The Agreement to Arbitrate accompanying this Application must be read and
signed in order to be considered for employment with the Company. By signing the Agreement to Arbitrate I understand that the employment AT-WILL
relationship will not be altered.
I HEREBY ACKNOWLEDGE AND UNDERSTAND THE NOTICE AS DESCRIBED ABOVE AND THAT IF I AM HIRED I WILL BE AN AT-WILL EMPLOYEE.
SIGNATURE: _________________________________________ DATE: ______________________________________________
AGREEMENT TO ARBITRATE
Brinker Internation al Payroll Compan y, L.P. (“Brinker” ) makes available c ertain internal pro cedures for amica bly resolving any complaints or dis putes you hav e relating
to your employm ent. Howev er, if yo u are unab le to resolv e any such c omplain ts or disput es to your satisfac tion in ternally, Br i nker has prov ided f or the resol ution of all
disputes that arise between you and Brinker through formal, mandatory arbitration before a neutral arbitrator.
Because of, among other things, the delay and expense which result from the use of the court systems, any legal or equitable claims or disputes arising out of or in
connection with e mployment, terms and c onditions of emp loyment, or the term ination of empl oyment with Brinker will be resolved by b inding arbitr ation instead of i n a
court of law or equity. This agreement applies to a ll d is putes i nv olv in g le g ally pro tec ted rights (e.g., loc al, st at e and f ed eral statutory , c ontrac tua l or common law rights )
regardless of w hether the statute wa s enacted or the comm on law doctrine was reco gnized at the time this agreement was si gned. This agreement does not limit an
employee’s ability to complete any external administrative remedy (such as with the EEOC).
This Agreement to Arbitrate substitutes one le gitimate dispute resolution form (arbitration) for another (l itigation), thereby waiving any right of either party to have the
dispute resolved in court. This substitution involves no surrender, by either party, or any substantive statutory or common law benef its , protec ti on or defens e .
Arbitration Rules:
The arbitration proceedings shall take place in or near the city where you worked.
Each party is entitled to representation by an attorney throughout the arbitration pr oc eed ing s at their own expense. Each part y s hall b ear t heir own fees and expenses,
unless otherwise awarded by the arbitrator in the final, written decision.
A written notice of your intentio n to arbitrate must be submitted i n writing within the applicabl e statute of limitations. The n otice shall contain: (1) the name, ad dress
and telephone number for al l the parties; (2) the name, address and tele phone numbers of all counsel; (3) a brief stateme nt of the nature of the dispute, including all
claims raised; (4) the amount in controversy and (5) the remedy sought. The notice shall be sent to: General Counsel, Brinker International, 6820 LBJ Freeway,
Dallas, TX 75240.
The Respondent shall answer in writing within thirty (30) business days of the receipt of the notice to arbitrate.
Within ten (10) bus ines s day s there after, bot h parties shall sub mit t o th e other a lis t o f thre e (3) qualified arbitrators . An arbitrat or mus t b e qu ali f ie d in e mp loy me nt l aws
and any other areas of law referenced in the notice.
An arbitrator shall be sel ected withi n thirty (30) busines s days thereafter. If th e parti es c annot a gree, they shal l subm it an y plead ings (n otice, answer, etc.) and a list of
arbitrators to the American Arbitration Association (AAA) to select a qualified arbitrator. AAA may select an individual not on either party’s list.
The Federal Rules of Civ il Procedure and Federal Ru les of Evidence shal l apply throughout the ar bitration unless modif ied by the mut ual agreement of the p arties, or
the arbitrator.
Discovery (interrogatories, document production and depositions), as authorized by the arbitrator, shall commence upon the selection of an arbitrator and shall be
completed within six (6) months from that date. The time frame may be modified by mutual agreement, or by the arbitrator.
The arbitrator shall hear the case no more than forty-five (45) business days after discovery is completed.
Parties may submit briefs and one rebuttal brief or such other submittals as the arbitrator decides.
Within twenty (20) days of the c lose of the hearing, the arbitrator shall iss ue a written decision an d award (if any) stating t he reasons for the d ecision and award. Th e
decision shall be final and binding on both parties, their heirs, executors, administrators, successors and assigns, and may be entered and enforced in any court of
competent jurisd ic tion . Proc ee di ngs to enforce, confirm, mo dify or v ac at e the d ec is ion will be controlle d by a n d c ond uc ted in conformity with t he Federal Arbitrat io n Act
9 U.S.C. Sec. 1 et seq. or applicable state law.
By signing below, I affirm that I have read the above Agreement to Arbitrate and agree to resolve all disputes that a rise between me and Brinker through
formal, mandatory arbitration as outlined above. I further understand and agree that the Agreement to Arbitrate does not change or alter my at-will
employment status.
_______________________________ ________________________________
SIGNATURE OF APPLICANT DATE
[Revised 9/2008]
