Full-Time
Position Applying for:
Part-Time
Available
Weekends
Swingshift
Store:
Lacey
Tillicum
Tacoma
Puyallup
Federal Way
Bremerton
Kent
Renton
Everett
Last Name
First Name
Middle Initial
Date of Birth
SSN
City
Zip
Address
Cell Phone
Home Phone
E-mail
Full-Time
Part-Time
Available
Weekends
Swingshift
                                             Name, City, State                                                                             Dates                                            Degree
High School

College

Other
Company and Address (If current employer, may we contact them?)
Yes
No
Supervisor
Phone
Dates Worked
Last Salary
What did you do?
Company and Address (If current employer, may we contact them?)
Yes
No
Supervisor
Phone
Dates Worked
Last Salary
What did you do?
Company and Address (If current employer, may we contact them?)
Yes
No
Supervisor
Phone
Dates Worked
Last Salary
What did you do?
References
Phone
State
City
Name                                             Relationship
Other Information About You
Yes
Are you at least 16 years old?

Have you ever filed an application with Popeyes before?

Have you ever been employed with Popeyes? If Yes, Where & When

Do you have relatives employed with Popeyes? If Yes, List Names

Do you have friends employed with Popeyes? If Yes, List Names

Are you employed now?

Are you willing to have a drug screen?

Have you ever been convicted of a crime (not including minor traffic violations)?

Are you currently charged with a crime?

Have you ever threatened or committed an act of violence, harassment, or discrimination?

Are you prevented from becoming lawfully employed in this country because of Visa or
Immigration Status?
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Nature of My Employment. If I work for Popeyes, I agree that I will be an at will employee, which means that either I or Popeyes may
end my employment at anytime, with or without cause. I agree that no written materials or verbal statements by Popeyes will
constitute an express or implied contract of employment. I agree that I will treat confidentially all information I will learn in the course
of my employment with Popeyes.

My Participation in Popeye's Drug Free Environment. I am not a current user of illegal drugs, and I agree I will never work under the
influence of drugs or alcohol. I agree to submit to any lawful test for illegal use of drugs, or working under the influence of alcohol. I
agree that Popeyes may refuse to hire me, or may terminate my employment, if I fail, or refuse to submit to, such a test at any time.

Applicant's Signature:                                                                                                   Date: