Aqui Cal-Mex

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Employment

O.M., Incorporated dba Aqui Cal-Mex

Personal Information

Full Name
Current Address
Primary Telephone		Secondary Telephone
Are you 18 or over?	Yes No [ Because alcohol is served, you must be 18 or over to apply ]
Are you legally authorized to work in the U.S.?	Yes No [ Proof of eligibility will be required upon employment ]
Have you ever been convicted of a crime?	Yes No Please explain below [ Note: You do not need to identify convictions that have been sealed, expunged, dismissed, or otherwise eradicated by statute or court order, any conviction for a marijuana offense if the conviction is more than two years old, or any information pertaining to referral or participation in any pre-trial or post-trial diversion program. Such conviction may be relevant if job-related, but does not necessarily bar you from employment. ]

Availability

Please indicate when you are available to work [ Please specify the hours for each day ] Sunday: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday:
What is your pay expectation?
When could you start?
What planned vacations or extended time off do you need in the next 6 months?
How long would you like to work at Aqui?

Education

	Name & Location	Years Completed	Degree	Major
High School
College
Additional Training

Work Experience

List your last three employers, starting with the most recent. You may also include Non-paid volunteer experience or extracurricular activities.

Dates Employed		Hours per week
Company & Address		Position & Duties
Supervisor & Phone		Reason for Leaving
Rate of Pay		May we contact for a reference? Yes No

Dates Employed		Hours per week
Company & Address		Position & Duties
Supervisor & Phone		Reason for Leaving
Rate of Pay		May we contact for a reference? Yes No

Dates Employed		Hours per week
Company & Address		Position & Duties
Supervisor & Phone		Reason for Leaving
Rate of Pay		May we contact for a reference? Yes No

Have you been employed with Aqui before?	Yes No Please state where, when and your reason for leaving:
Have you applied with Aqui before?	Yes No Please state where and when; with whom did you interview?:
Have you ever been dismissed or forced to resign from employment?	Yes No Please explain:
Do you have a current Food Handler Card?	Yes No by what date could you acquire one?

References

Please provide contact information for one personal and one professional reference. The professional reference should be a present or previous supervisor (not related to you). A supervisory reference from school, volunteer organization or extracurricular interest is acceptable if no others are available.

Name		Phone Number
Title
How acquainted and for how long?

Name		Phone Number
Title
How acquainted and for how long?

Supplemental Information

What do you think you will enjoy about working at Aqui?

What is your definition of great customer service?

Have you ever visited Aqui as a customer? What did you most like about that experience?

Nearly every senior person at Aqui began in an entry-level position. Is there anything you hope to learn from us, or a position you hope to grow into one day?

Certification

Please read carefully, initial each paragraph and sign below:
[initials]	I hereby certify that I have not knowingly withheld or misrepresented any information pertaining to my application for employment and that the answers given by me are true and correct to the best of my knowledge. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
[initials]	I hereby authorize O.M., Incorporated to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed, or any additional references identified by me or O.M., Incorporated, to provide any relevant information regarding my current and/or previous employment. In addition, I hereby release all persons, schools and employers of any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
[initials]	I understand and agree that, if employed, my employment with O.M. Incorporated is at-will and can be terminated with or without cause and with or without notice at the option of either me or O.M., Incorporated. No manager or representative of O.M., Incorporated, other than the President, has the authority to enter into any agreement of employment for any specified period of time or to make any agreement contrary to this at-will relationship. Any such agreement must be in writing and signed by the President and me. This express at-will agreement constitutes the entire agreement between me and O.M., Inc. with respect to the duration of my employment or the circumstances or conditions under which my employment may be terminated. This at-will agreement supersedes and precludes the existence of any contrary agreements, expressed or implied.
[initials]	I understand and agree that, if hired, upon termination of my employment I will promptly return all property belonging to O.M., Inc., including but not limited to, keys and computer equipment.
Signature: (please sign by typing your first and last name) Date:

We E-Verify
O.M., Inc. is an equal opportunity employer

Menu and prices subject to change without notice. Prices do not include tax.

Downtown Willow Glen · 1145 Lincoln Ave., San Jose CA · (408) 995-0381
Blossom Valley · 5679 Snell Ave., San Jose CA · (408) 362-3456
Downtown Campbell · 201 E. Campbell Ave., Campbell, CA · (408) 374-2784
Cupertino · 10630 S. De Anza Blvd., Cupertino, CA · (408) 996-1443

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