Concord Hospitality, Inc. is an equal opportunity employer, and will not permit discrimination on the basis of race, color, sex, age, national origin, ancestry, religion, citizenship, veteran status, marital status, disability, or any other category protected by state, federal, or local law. Employment related decisions, such as hiring, promotion, training, and discipline will be made for legitimate business reasons based upon qualifications and other non-discriminatory factors. Concord Hospitality, Inc. complies with all federal, state, and local laws, rules and regulations pertaining to equal employment opportunity. Instructions for Completing the Application: Please print all information clearly using blue or black ink. An incomplete application will not used when considering applicants for employment. It is important that each section is filled out completely. If you have a resume, it is still necessary that the entire application be completed. If you have any questions, or need assistance completing this application, including providing reasonable accommodation to known disabilities, or any other protected category under state, federal or local law, please contact a member of management. Thank you for your interest!
   
Position Sought:                   Today's Date:
Referral Source: Newspaper      Radio      Internet      School      Walk-in
                          State Agency    Other   Referred By
Name
                     (Last)                            (First)                           (Middle)       
Address
                        (Street)                          (City)                          (State)               (Zip)  
Phone No.               Alternate Phone Number
Are you 18 years of age or older?....................................................................................................... Yes No
Have you ever worked for any division of the Company before? ........................................................ Yes No
(This may include, but not be limited to, Concord Neighborhood Corp., Concord Hospitality Inc.,
Concord B-Que Corp., Concord Enterprises, Inc., MicroLNK, and KMS,LLC.)
If yes, please provide location, dates of service and immediate supervisor:
So you have a legal right to work in the United States? ..................................................................... Yes No
(Proof of eligibility will be required upon offer of employment.)
Have you been convicted of a felony or misdemeanor?........................................................................ Yes No
(Conviction will not necessarily disqualify an applicant from employment) If yes, please explain:
Are you willing to work:
(Mark all that apply) 		Full-Time (40 or more hours each week)
Part-Time (Less than 40 hours each week)
Temporary (i.e.: summer months, during school, etc.) Explain:
       # of shifts available per week     Date Available to Start:
Dates and Hours
of Availability
Day: Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From:
To:
  (If employed, employees are required to notify their supervisor, in writing, of any changes in my availability. Note: Changes in eligibility may have an effect on an individual's employment status.)
Each position with the Company has different requirements and functions, if you are not familiar with the position you are applying for, please request a job description. Are you able to meet the requirements of this position, with or without reasonable accommodation? ................................................................................................ Yes No
If no, please describe any accommodations that would be required (reasonable accommodations will be provided for known disabilities):
Are you able to travel if your jobs requires it? ..................................................................................... Yes No
Are you able to relocate if your job requires it? ................................................................................... Yes No
Educational Background (Job-Related)
Please provide the name, location, and other requested information of the last three (3) schools attended.
School Name Location # of Years Completed Degree/Diploma Area of Study
(Major/Minor)
Skills and Qualifications - Summarize any special training, skills, licensures, certificates, awards, accomplishments and/or any other information that may qualify you as having the ability to perform the job-related functions of the position which you are applying for:
References - List the name, title (if applicable), and day-time phone number of three (3) business/work references that are not related to you and are not previous supervisors. If not available, list three (3) school or personal references who are not related to you.
Name Title Telephone Number Years Known
Employment History
Please provide the following information for your past and current employers, starting with the most recent.
EMPLOYER NAME TELEPHONE
DATES EMPLOYED SUMMARY OF DUTIES
FROM TO
ADDRESS
JOB TITLE HOURLY RATE/
SALARY STARTING
IMMEDIATE SUPERVISOR AND TITLE
$ PER
REASON FOR LEAVING
 HOURLY RATE/
SALARY FINAL
MAY WE CONTACT FOR A REFERENCE?
Yes No Upon Offer
$ PER
 
EMPLOYER NAME TELEPHONE
DATES EMPLOYED SUMMARY OF DUTIES
FROM TO
ADDRESS
JOB TITLE HOURLY RATE/
SALARY STARTING
IMMEDIATE SUPERVISOR AND TITLE
$ PER
REASON FOR LEAVING
 HOURLY RATE/
SALARY FINAL
MAY WE CONTACT FOR A REFERENCE?
Yes No Upon Offer
$ PER
 
EMPLOYER NAME TELEPHONE
DATES EMPLOYED SUMMARY OF DUTIES
FROM TO
ADDRESS
JOB TITLE HOURLY RATE/
SALARY STARTING
IMMEDIATE SUPERVISOR AND TITLE
$ PER
REASON FOR LEAVING
 HOURLY RATE/
SALARY FINAL
MAY WE CONTACT FOR A REFERENCE?
Yes No Upon Offer
$ PER
 
EMPLOYER NAME TELEPHONE
DATES EMPLOYED SUMMARY OF DUTIES
FROM TO
ADDRESS
JOB TITLE HOURLY RATE/
SALARY STARTING
IMMEDIATE SUPERVISOR AND TITLE
$ PER
REASON FOR LEAVING
 HOURLY RATE/
SALARY FINAL
MAY WE CONTACT FOR A REFERENCE?
Yes No Upon Offer
$ PER
Please explain any gap in employment:
Authorization and Understanding (Please Read Carefully Before Signing):

I hereby certify that all the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any fact in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Concord Neighborhood Corporation (hereinafter referred to as “the Company”) that such employment with the Company is at will, for no specified duration and may be terminated by either the Company or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions or statements by the Company or its representatives used during the employment process may be deemed a contract of employment, real or implied. I understand that no representative of the Company except the President has the authority to enter into any agreement guaranteeing conditions of employment or any agreement contrary to the foregoing statements and that any such agreement must be made in writing and signed by the President of the Company.

I acknowledge that, through this document, I have been advised that the Company does promote and expect a drug and alcohol free workplace. If I am extended an offer of employment, I understand that the Company will provide me with all information regarding this program, and that I will be expected to comply with the requirements of this policy, as well as all other policies, including compliance with policies concerning equal opportunity, anti-retaliation, and fair treatment. Failure to do so will result in corrective action, up to and including termination.

With my signature below, I understand that I may be asked to submit to a criminal background check, based on the position for which I have applied. I acknowledge that the results of this background check will be considered when making a determination regarding the Company’s decision to extend an offer of employment to me.

I understand I must provide legally acceptable documentation to establish my identity and eligibility to work in the United States. If I am offered a position with the Company, and I fail to provide this evidence it will result in the termination of my employment.

In consideration for employment with the Company, if employed, I agree to conform to the rules, regulations, policies and procedures of the Company at all times and understand that this is a condition of employment. I understand that due to the nature of the Company’s businesses, attendance and punctuality are considered essential requirements of every job at the Company, and that poor attendance or tardiness will result in corrective action, which could include termination.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to the Company and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application is considered current for three (3) months. If I wish to be considered for employment after this period, or for a position other than that for which I applied, I must complete and submit a new application.
BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.
Applicant Signature


Name and Phone Number of Person Completing This Form Other than Applicant
 Date


Signature