PLEASE PRINT CLEARLY, COMPLETE ALL ITEMS Date Name Present Address Previous Address Last First Middle Street City State Zip Street City State Zip If under 18 years of age a work permit or certificate may be required as a condition of employment. Age (check one): q Under 16 q 16 or 17 q 18 or over If you are hired, you will be required to provide verification of your legal right to work in the United States. Are you legally authorized to work in the United States? qYes q No Have you ever worked for El Pollo Loco before? If yes, when? qYes q No From To Location How did you learn of our organization? q Walk-In q Newspaper q School q Internet qReferral qAgency q Other_____________ Policy prohibits the employment of relatives in the same restaurant in a supervisory relationship. Do you have any relatives currently working for El Pollo Loco? qYes q No If yes, give the job title and location of the restaurant where your relative is employed. __________________________ EMPLOYMENT DESIRED Days and Hours available to work: Position: Salary Requirements: Date you can start: q Check here if available any hours. If restrictions, indicate available hours below. From To Mon Tue Wed Thu Fri Sat Sun # of Years Completed Graduated qYes q No qYes q No qYes q No REFERENCES List the names of three persons not related to you, whom you have known at least one year. Name Phone Address Business Years Known 1 2 3 Business, Trade, Other APPLICATION FOR EMPLOYMENT Equal Opportunity Employer EDUCATION High School Name and Location Course of Study College Social Security # Phone # PERSONAL INFORMATION Have you ever been convicted of a crime? qYes q No You need not disclose, 1.) convictions for marijuana-related offenses that are more than two years old; 2.) any information regarding your participation in or referral to any diversion program; 3.) convictions that have been sealed, expunged or legally eradicated; and 4.) misdemeanor convictions for which probation was completed and the case was dismissed. If yes, briefly describe the nature of the crime(s), the date and place of conviction, and the legal disposition of the case: A conviction will not necessarily disqualify you from employment. Unit Stamp Degree Received
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