Apply for Shift Leader position

APPLICATION FOR EMPLOYMENT

Potbelly Sandwich Shop is an Equal Opportunity Employer and we consider all applicants for employment without regard to race, color, sex, religion, age, national origin, disability, veteran status, or any other basis as prohibited by federal, state or local law. Potbelly is committed to complying with the American With Disabilities Act. If you require a reasonable accommodation to apply for or to complete an application for employment or to perform the essential functions of the job for which you are applying due to a disability, please notify Potbelly of your specific needs for a reasonable accommodation so that Potbelly can assist you where appropriate.

Please complete entire application.
PERSONAL INFORMATION
  Today's Date
 
Name: First Last Middle

Are you 18 years of age or older?
Yes    No
Are you eligible for employment in the United States?
Yes    No  
(Proof will be required if hired.)
   

Have you ever been involuntarily discharged?
If yes, please explain:
Yes    No

Interested in Part Time    Full Time

Have you ever been convicted of a crime?  Yes    No
(You are not required nor will you be asked to report whether you have conviction records that have been expunged, sealed or impounded.)
If yes, explain in the space below. For each conviction, include the specific offense(s) for which you were convicted, the county and state in which you were convicted, and the date for each. An applicant will not be denied employment solely on the grounds of a conviction. The nature of the offense, the date of the offense, the seriousness of the offense, the surrounding circumstances and the relevance to the position applied for may, however, be considered.
Complete Address:
Street Apartment No. City State Zip
Daytime Phone: (xxx) xxx-xxxx Evening Phone: (xxx) xxx-xxxx
Email Address:
How did you hear about Potbelly?
    		Please specify source.
 Have you ever applied to Potbelly before?
Yes No
EMPLOYMENT DESIRED(If you are applying for a retail hourly position, please keep in mind that the availability of hours may vary.)
What position are you applying for?

 What location?


Other locations you would be willing to work?
(use ctrl-click to select multiple locations) 		What date can you start?


Salary desired?
Specify hours available to work for each day of the week:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Have you ever worked at Potbelly before?
Yes No		 If yes, when?
From: To: 		Which store/department?
EDUCATION
  Name of School
(Enter "none" if did not attend)		 Years Completed Did You Graduate?
High School: Yes No
College: Yes No
Other: Yes No n/a
Major or Field of Study:
List skills relevant to the position you are applying for:
ADDITIONAL QUESTIONS
Have you ever visited a Potbelly location? Where? Describe your experience.
What do you like about Potbelly?
Why would you like to work for Potbelly Sandwich Shop?
Describe a specific situation where you have provided excellent customer service.
FORMER EMPLOYERSBelow list your current and last three employers, starting with the most recent one first. Please include any non-paid/volunteer experience which is related to the job for which you are applying. Please complete even if you attach a resume.

Dates Worked Current/Most Recent Employer Salary or Hourly Position Reason for Leaving
From: (MM/YYYY)
To: (MM/YYYY or 'Present')
Employer Name
City
 State
Starting:
(Bonus)
Ending:
(Bonus)


Duties Performed:
Supervisor's Name: Phone:
(xxx) xxx-xxxx		 May we contact? Yes No
Supervisor's Title:
Dates Worked Salary or Hourly Position Reason for Leaving
From: (MM/YYYY)
To: (MM/YYYY or 'Present')
Employer Name
City
 State
Starting:
(Bonus)
Ending:
(Bonus)


Duties Performed:
Supervisor's Name: Phone:
(xxx) xxx-xxxx		 May we contact? Yes No
Supervisor's Title:
Dates Worked Salary or Hourly Position Reason for Leaving
From: (MM/YYYY)
To: (MM/YYYY or 'Present')
Employer Name
City
 State
Starting:
(Bonus)
Ending:
(Bonus)


Duties Performed:
Supervisor's Name: Phone:
(xxx) xxx-xxxx		 May we contact? Yes No
Supervisor's Title:
Dates Worked Salary or Hourly Position Reason for Leaving
From: (MM/YYYY)
To: (MM/YYYY or 'Present')
Employer Name
City
 State
Starting:
(Bonus)
Ending:
(Bonus)


Duties Performed:
Supervisor's Name: Phone:
(xxx) xxx-xxxx		 May we contact? Yes No
Supervisor's Title:
Please list and explain any gaps of employment:
PROFESSIONAL REFERENCES List names of three professional references, whom you have known at least one year. If not previously employed, list personal references.
  Name Phone Number Name of Business Years Acquainted
1.
Relationship (supervisor, peer, ...)


(xxx) xxx-xxxx
2.
Relationship (supervisor, peer,...)


(xxx) xxx-xxxx
3.
Relationship (supervisor, peer,...)


(xxx) xxx-xxxx

By checking the signature box on the bottom of this application, I certify that the following information in this employment application (and accompanying resume or documentation, if any) is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered at a later date. I agree to immediately notify Potbelly Sandwich Shop if I should be convicted of a felony, any crime involving dishonesty, breach of trust, controlled substances, sexual misconduct, abuse or violence, while my job application is pending or during my period of employment, if hired.

I authorize Potbelly to investigate any of the information contained on this application, including the examination of past employment records, references, and other facts stated on this application. I waive any right I may have to be notified by any of the individuals and organizations named in this application prior to the release of any information to Potbelly. I further authorize all individuals and organizations named in this application to provide Potbelly all information relative to such verification. I hereby release such individuals and organizations and Potbelly from any and all liability for any claim or damage resulting therefrom.  

I understand that neither this application nor anything conveyed during the interview process, if granted, is intended to create a contract of employment. I understand that, if hired, I am obliged to comply with any and all current and subsequently adopted Potbelly Sandwich Shop policies. I understand and agree that, if hired, my employment is at-will, meaning that it is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time for any reason, with or without notice. I understand that no person is authorized to change any of the terms mentioned in this employment application and that no manager or representative of the Company, other than Potbelly’s President or Ownership, have any authority to enter into an agreement with me for employment for a specified period of time. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and the Company’s President and Ownership.

I also understand that as a condition of employment, if hired, I will be required to provide evidence of identity and employment eligibility in the United States.

I understand that as part of my application for employment, I must sign a release of information authorization. This is to allow the Company to verify my references and, in the Company’s discretion, to perform other background investigations to determine my qualifications for employment. Through a separate agency, the Company may investigate my academic credentials, prior employment, personal/professional references, credit record, motor vehicle record and/or criminal record.   

 
Please check this signature box to certify that all of the above information is correct  Date:



WE ARE AN EQUAL OPPORTUNITY EMPLOYER COMMITTED TO HIRING A DIVERSE WORKFORCE

Rev. 4/1/09