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Tropical Smoothie Job Application Form

To apply for a job at a Tropical Smoothie establishment, interested individual must accomplish this form and submit the completed copy to the site administrator or manager.

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”Tropical Smoothie Cafe  Page 1 of 4  9/09 	
APPLICATION FOR EMPLOYMENT 	
 	
Tropical  Smoothie  Café  (“TSC”)  is  an  equal 	opportunity  employer  and  does  not  discriminat	e  in  recruiting,  hiring,  training,  prom	oting  or  other 	
employment practices on the basis of race, color, religion, se	x, age, marital status, pregnancy, national origin, political aff	iliation, familial status, 	
disability,  sexual  orientation  or  veteran  status.    No  question 	in  this  application  is  intended  to  obtain  information  to  be  used	 for such 	
discrimination and you may omit any information that would disclose any basis for discrimination.  
Please complete this form in your own handwriting and in ink, even 	if including a resume.  We ask that you fill in all informat	ion.  If you require 	
additional space for answers, please use an additional sheet of paper.   
 
Personal Information	 	
Last Name 
 
 
 	
First Name  MI  Social Security Number  Telephone Number  E-Mail 	
 
 
 	
Street Address 
 
 
 	
City  State  Zip 	
 
 
 	 
If we are unable to contact you at the address/te	lephone number listed above, where may you be reached? 	Address 	Telephone Number    	 
Are you 18 years of age or older?  Yes   No     If 	not, do you have the proper work permits?  Yes    No  	
Have you previously been employed with TSC?   If yes, when, where, and in what position?              
 
     	Yes   No  	
Have you previously applied for employment with TS	C?  If yes, when, where, and in what position?  	
 
     	Yes   No  	
Have you ever been refused bond?       	Yes   No	             If yes, state the reason and date bond was refused.  	
 
 
 
Job Requirements	 	
Indicate specific position desired  
 
Do you know any reason why you cannot perform the essential func	tions of the job for which you are applying, with or without 	
reasonable accommodations?       	Yes   No	  	If Yes, please explain	 	
 
 
Can you work the regular hours/days/shifts of th	e job for which you are applying?  Salary Sought 	
 
                      
 	
For positions requiring weekend work: 
Can you work weekends?  
Yes   No    	
Can you work overtime?  
    Yes   No     	
Check appropriate employment desired:  
   ‰	Full Time      	          	‰	Part Time      	          	‰	Temporary 	 	
What date would you be available to begin work?

”Tropical Smoothie Cafe  Page 2 of 4  9/09 
Education, Training and Skills	                	                	                	                	                	                	                	               	        	
             School Attended                                              Name & Location                                      	    Major                                Degree	        	
High School 
 	
  	  	  	
Business or Technical School 
 	
  	  	  	
College 
 	
  	  	  	
College 
 	
  	  	  	
Graduate School 
 	
  	  	  	
Special Training Courses 
 	
  	  	  	
    
Do you plan to continue formal education?      Yes   No   If Yes, when, where and what courses? 	_______________________ 	
_____________________________	______________________	______________________	________________ 	
 
List any academic or community activities, honors, and office	s that you presently hold or have held in the past. _____________ 	
_____________________________	______________________	______________________	_____________ 	
 
For positions requiring foreign language: 
What language(s) do you speak, read or write?  (Indicate languages) 	__________________________	______________ 	
 
Briefly describe below your interests, sk	ills, and aptitudes that you feel qualify you for a position with TSC.  If you need mo	re space, please 	
continue on a separate sheet of paper. 	____________________________	_______________________ 	
_____________________________	______________________	______________________	_____________ 	
 
Employment Experience	 	
Have you ever been discharged or asked to resign from a position?  	   Yes   No     If Yes, explain the circumstances. _________	___ 	
_____________________________	______________________	______________________	_______________ 	
 
Have you ever held a position of trust (handling money or confi	dential material)?  Yes   No   If yes, please specify __________	_ 	
_____________________________	______________________	______________________	_____________ 	
 
Does your present employer know of your	 plans to change employment?  Yes   No   If not, when may we contact your employer? 	
_____________________________	______________________	______________________	_____________________	
_____________________________	__________________________	_______________________ 	
 
Briefly state why you desire to make a change in employment.  ____________________________________________________ 
_____________________________	______________________	______________________	_____________ 	  
Please  account  for  all  jobs  held  within  the  past  five  (5)  years 	beginning  with  your  present  or  most  recent  employer.    Include  p	art-time 	
employment,  summer  or  temporary  employment  and  military  service 	(show  rank  and  date  of  discharge).    If  necessary,  you  may  attac	h 	
additional  sheets  of  paper  in  order  to  list  all  prior  jobs  held. 	 Please continue to list the requested information in the form	at  below.    If  your 	
resume is attached, you still need to complete this section thoroughly.  Resume attached?  Yes   No   Employment Dates Month/Year	 	Company Name, Address & Phone Number	 	Salary	 	Start        Final	 	    Position	 	Supervisors	 	Name	 	Reason for Leaving	 	
 	
 From	 	
_____________ To 
_____________ 	
 
 	
 $                $  Per             Per	 	
 
 	
 
 	
 
 	
 
Duties:_________________________________________________________________________________________________

”Tropical Smoothie Cafe  Page 3 of 4  9/09 
Employment Experience (continued)	 	  Employment Dates Month/Year	 	Company Name, Address & Phone Number	 	Salary	 	Start        Final	 	Position	 	 Supervisor’s Name	 	Reason for Leaving	 	
 From	 	
_____________ To 
_____________ 	
 
 	
 $                $  Per             Per	 	
 
 	
 
 	
 
 	
 
Duties:_________________________________________________________________________________________________  
 
Employment Dates Month/Year	 	Company Name, Address & Phone Number	 	Salary	 	Start        Final	 	Position	 	Supervisor’s Name	 	Reason for Leaving	 	
 From	 	
_____________ To 
_____________ 	
 
 	
 $                $  Per             Per	 	
 
 	
 
 	
 
 	
 
Duties:_________________________________________________________________________________________________  
 
General Information	 	 
All Applicants: 
(For positions requiring driving): 
Do you have a valid driver’s license? Yes   No.  Has your driver	’s license ever been revoked?  Yes   No.  If yes, state date an	d reason for 	
revocation. _____________________________________________________________________________________  
All Applicants EXCEPT Applicants Seeking Employment	 in California, Colorado,	 Hawaii, Massachusetts, New 	
Jersey, Ohio and Wisconsin. 
Have you been convicted of a felony within the last sev	en (7) years?  Yes   No.  If yes, please explain. _____________________ 	                    	                 	 	
____________________________________________________________________________	______________________ 	
 (Note: Conviction of a felony will not	 necessarily disqualify you from employment.  Factors such as age at the time of offense, date, 	
seriousness and nature of the offense, and rehabilitation will be taken into account.)  
Only for Applicants Seeking Employment in California. 
Have you ever been convicted of a crime, except for conviction	s of crimes involving marijuana dating more than two (2) years ag	o, that was 	
not expunged from your record, and did not result	 in referral to, or participation in, any pretrial 	or post-trial diversion program?  Yes   No.  If 	
yes, please explain.  ______________________________________________	_____________                                                                                           	 	
_______________________________________________________________________________________________________ 
 (Note: Conviction of a crime will not	 necessarily disqualify you from employment.  Factors such as age at the time of offense, date, 	
seriousness and nature of the offense, and rehabilitation will be taken into account.) 
 
Are you presently out on bail or your 	own recognizance pending trial?  Yes   No.  If yes, please explain.  ___________________ 	
_______________________________________________________________________________________________________ 
_____________________________	______________________	______________________	_____________ 	 
Only for Applicants Seeking Employment in Florida:	   	
Have you ever been convicted of a crime, excluding minor traffic o	ffenses?  Yes   No.   If yes, state offense, date, court, loc	ation, disposition of 	
case, and any rehabilitation._____________________________________________________________________ 
_____________________________	______________________	______________________	_____________ 	
(Note: Conviction of a crime will not	 necessarily disqualify you from employment.  The above factors will be taken into consideration in 	
determining the effect on your suitability for employment). 
 
Has a court of law ever withheld adjudication for a crime for whic	h you were charged?  Yes   No.  If yes, state offense, date, 	court, location, 	
disposition of case, and any rehabilitation. ________________________________________________________ 
_____________________________	______________________	______________________	_____________ 	
(Note: A courts adjudication of guilt being withheld will not	 necessarily disqualify you from employm	ent.  The above factors will be taken into 	
consideration in determining the effect on your suitability for employment).

”Tropical Smoothie Cafe  Page 4 of 4  9/09 
CERTIFICATION AND AGREEMENT	 - Please read the following statements carefully before signing.  If you have any questions regarding 	
these conditions of employment, please ask them of the employment interviewer before signing. 
 
(A)  This application will be given every consideration, but 	its receipt does not imply that I will be employed.   	 
(B)  I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my 	employment, if 	
hired, is intended to create an employment contract between me and TSC.  In addition, I understand and agree that if I am emplo	yed, my employment 	
is  for  no  definite  terms  or  determinable  period  and  may  be  terminated  at  any  time,  with  or  without  prior  notice,  at  the  option 	of either myself or TSC, 	
and that no promises or representations contrary to the foregoing are binding on TSC unless made in writing and signed by me an	d the President of 	
TSC.  
(C)  I  hereby  authorize  TSC  to  investigate  thoroughly  my  references,  work  record,  education  and  other  matters  related  to  my  suit	ability  for 	
employment and, further, authorize the references I have listed to disclose to TSC any and all letters, reports and other infor	mation related to my work 	
records,  without  giving  me  prior  notice  of  such  disclosure.    In  addition,  I  hereby  release  TSC,  my  former  employers  and  all  oth	er  persons, 	
corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way relate	d to such investigation or 	
disclosure.  
(D)  Without  limiting  my  authorization  in  paragraph  (C)  above,  I  hereby  specifically  authorize  and  request  that  my  current  and  a	ll  former 	
employers furnish TSC with information about my employment record, including statements of the reason for the termination of my	 employment, work 	
performance,  abilities  and  other  qualities  pertinent  to  my  qualifications  for  employment;  hereby  releasing  them  and  TSC  from  al	l  liability  and 	
responsibility arising from any information provided.  
(E)  Should I be employed, I agree to read my Employee Handbook and sign an acknowledgment of receipt and understanding of the E	mployee 	
Handbook.    In  addition,  I  will  abide  by  TSC  policies  and  procedures 	during  my  employment,  if  hired.    I  fully  understand  that  al	l  information,  whether 	
written,  spoken  or  otherwise  communicated  or  obtained,  and  all  files  and  records  relating  to  the  business  of  TSC  or  to  anyone  w	ith  whom  TSC  has 	
dealings,  constitute  privileged  information  and  are  to  be  treated  in  a  strictly  confidential  manner.    I  fully  understand  and  ag	ree  that  should  I  be 	
employed,  I  am  not  to,  and  will  not  at  any  ti	me,  communicate  or  reveal  any  business  of 	TSC  or  any  such  information,  records,  fi	les,  or  the  matters 	
contained  therein  to  unauthorized  personnel  within  TSC  or  to  anyone  outside  TSC.      I  also  understand  any  violation  of  the  foreg	oing  may  result  in 	
disciplinary action, including termination of employment.  
(F)  I  fully  understand  that  TSC  employs  only  U.S.  citizens  and  properly  authorized  aliens,  and  that  should  I  become  employed,  f	ederal  law 	
requires  me  to  furnish  to  TSC  proof  of  my  identity  and  employment  authorization,  and  to  sign  a  statement  under  penalty  of  perju	ry  verifying  my 	
eligibility for employment as a citizen or national of the United States or an otherwise employable alien.  
(G)	 	I  understand  that  TSC  has  a  policy  against  the  use,  possession  or  distribution  of  illegal  drugs,  including  the  abuse  of  alcohol	 by it 	
employees.    I  further  understand  that  TSC  has  a  Drug  Free  Workplace  Policy,  and  understand  that  violation  of  this  Policy  may  re	sult  in  disciplinary 	
action up to and including termination.  
(H)	 	I  understand  that  TSC  will  fully  cooperate  with  any  requests  by  law  enforcement  agencies  for  access  to  employee  files  and/or  in	formation 	
contained  in  this  employment  application  pursuant  to  federal,  state  and/or  local  laws,  including  but  not  limited  to  the  U.S.  Pa	triot  Act.   Accordingly,  I 	
understand that I have no expectations of privacy concerning any in	formation I have provided TSC in this employment application	, and/or concerning 	
any  information  TSC  may  obtain  in  connection  with  this  employment  application  or  any  future  employment  relationship  I  may  enter	 into with TSC.  I 	
hereby release TSC from all liability and responsibility arising from any information provided in accordance with applicable fe	deral, state  and/or local 	
law.  
I  CERTIFY  THAT  ALL  STATEMENTS  MADE  BY  ME  ON  THIS  APPL	ICATION  ARE  TRUE  AND  COMPLETE  TO  THE  BEST  OF  MY 	
KNOWLEDGE  AND  BELIEF  AND  THAT  I  HAVE  WITHHELD  NOTHING 	THAT  WOULD,  IF  DISCLOSED	,  AFFECT  THIS  APPLICATION 	
UNFAVORABLY.  I HEREBY ACKNOWLEDGE TH	AT I HAVE READ THE ABOVE CERTIFICAT	ION AND AGREEMENT STATEMENTS AND 	
UNDERSTAND  THE  SAME.    I  UNDERSTAND  THAT  ANY  MISREPRESENTATI	ON  OR  OMISSION  OF  FACT  IN  THIS  APPLICATION  OR 	
THE HIRING PROCESS WILL BE CAUSE FOR REFUSAL OF EMPL	OYMENT OR, IF EMPLOYED, TERMINATION FROM TSC. 	
 
Applicant Signatur	e: ___________________________	____    Date:  ___________________  	 
Disposition:  Date of Employment: 
 Company: 
Date of 1st Interview:  Title: 
Date of 2nd Interview:  Salary:     	              	             	          Per: 	
Interviews Comments:  90-Day Performance Evaluation Date: 	
Salary Review Date: 
Approval:
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