Application Must Be Filled out Completely in Order to Be Eligible for Hire

3101 Wisconsin Ave, NW Washington, DC 20016

EMPLOYMENT APPLICATION

Application must be filled out completely in order to be eligible for hire First Name Middle Name Last Name Date

Street/PO Box Apt. # City State Zip

Day Phone # Evening Phone # Social Security #

( ) ( ) | | Email Address: What is the best number to reach you at? Emergency Contact Name / Relation Day Phone # Evening Phone # ( ) ( ) Please check the position(s) for which you are applying:  Barista  Dishwasher  Counter Person  Bus Person  Cook  Manager

What is the minimum you are expecting to earn? $ / Hour (total including tips) What is your desired rate of pay? (Indicate in only one spot) $ / Hour (total including tips) Are you currently employed?  Yes  No If not, how long has it been since you were last employed?

1. How many hours a week are you available to work? ______hours 2. Please indicate what hours are you available to work (ex: 6am-10pm): MON TUES WED THUR FRI SAT SUN Hours available

3. Until what date does your indicated availability apply? Until: / /  No Restrictions Month Day Year

For Internal Use (not topical application) Only:  PA  P  Recommend for interview!  A  Q  Reason for no hire ______ E  I MOD ______4. Are you in school or taking any classes? YES NO If yes, what are your plans for breaks and holidays? (You may omit any statements indicating legally protected information) ______

5. Are you willing to work holidays and weekends? (Closed on Xmas & Thanksgiving Day) YES NO 6. Do you have a reliable means of transportation during hours of operation? YES NO

7. Do you have any scheduled obligations (i.e. weddings, exams, trips) coming up that we need to know about? YES NO If yes, please detail______

8. If we train on days or times when you have other obligations, are you willing to reschedule so that you can attend our training? YES NO 9. Have you ever trained others in the past? YES NO

10. Do you enjoy training others? YES NO

11. Do you have an interest in becoming a trainer? YES NO

12. Do you have an interest in working at our other restaurants? YES NO

13. How did you hear about us?  random/walk-in  regular customer  friend  employee  Washington Post  Washington Hispanic  internet (site)______

14. List people you know (if any) who are currently working or have worked at one of our locations: ______

15. Why are you interested in working here? ______

16. Have you ever applied to Open City at the National Cathedral before? YES NO If “Yes”, what was the result? ______

17. Have you held more than one job in the last 12 months? YES NO

18. If we offered you a job, how much notice do you need to give your employer (if you are currently employed)? ______If hired, when would you be able to start? ______

19. Have you ever been discharged from a job? YES NO If “Yes”, how many times?______Please explain the circumstances:______

20. Are you of the legal age to serve alcoholic beverages (18 to serve, 21 to bartend)? YES NO Have you served alcohol before? YES NO

21. Can you perform the essential functions required by the job for which you are applying? YES NO

22. Tell us anything you would like us to know about you: ______Please use the space below to list your employment history starting from your most recent and working back in time. Current or Most Recent JOB JOB 2 JOB 3 JOB 4

Name of Company

Address/Location

Name of Reference/Contact

Telephone # of Reference / Contact T T T T Dates of Employment From / o / From / o / From / o / From / o / Mo./Yr. Mo./Yr. Mo./Yr. Mo./Yr. Mo./Yr. Mo./Yr. Mo./Yr. Mo./Yr.

Your Job Title

Please describe your duties

Describe work related awards & promotions.

Average hours you worked per week Start ______Last Start ______Last Start ______Last Weekly gross income Start ______Last ______Start ______Last Start ______Last Start ______Last Hourly Rate Start ______Last ______

Reason for Leaving

Are you eligible for Rehire?  YES  NO  YES  NO  YES  NO  YES  NO

May we contact this  YES  NO  YES  NO  YES  NO  YES  NO employer?

Explain any Gaps in employment over 30 days between jobs In the space provided below, please list your educational history:

HIGH SCHOOL COLLEGE / UNIVERSITY GRADUATE / PROFESSIONAL School Name (City & State) Number of Years Completed Diploma/Degree Received (Month/Year Graduated)

Describe Course Studies

Describe any job-related training

Describe honors received

Do you speak, read or write in any other languages?  YES  NO If “Yes” please list the languages and detail your proficiency: (i.e. Fluent, well, so-so) ______Please use the space below to detail any additional skills or information you feel may be helpful to us in considering your application:

______

We consider applicants for all positions without regard to age, race, color, sex, religion, national origin, marital status, disability, sexual orientation, or any other legally protected status.

PLEASE READ THIS CAREFULLY BEFORE SIGNING

I certify that the answers given on this application are true and complete to the best of my knowledge. I authorize investigation of all statements in this application for employment as may be necessary for Open City at the National Cathedral (OCNC, Inc.) to arrive at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with OCNC, Inc. is of an “at will” nature, which means that a staff member may resign at any time and OCNC, Inc. may discharge a staff member at any time with or without cause. I understand that this “at will” employment relationship may not be changed unless such change is specifically acknowledged in writing by the President of OCNC, Inc. If I am hired, I understand that false, omitted, or misleading information in my application, resume, or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of OCNC, Inc. All offers of employment are conditional to the receipt of satisfactory evidence of my integrity and legal authority to work in the United States. Offers of employment may be conditional upon the successful completion of a criminal background check.

Signature ______Date ______

I understand that this application will remain active for 30 days from the date received.