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SPLLC APPLICATION FOR EMPLOYMENT DATE // 1. Name Last First Middle 2. Address City State ZIP 3. Telephone - E-Mail Address Are you at least age 16 4. List friends or relatives employed by this company Yes No 5. Have you ever worked for SPLLC Sizzler Red Robin Ruby River Hoppers Little Caesars before If so when 6. Utah Only Have you ever been convicted of a felony or a crime of moral turpitude Moral turpitude may be defined as any criminal conviction involving theft assault physical injury or the use or distribution of a controlled substance. POSITION APPLIED FOR 1. Jobs applied for Desired pay per hour. Hours Available Mon* Tues. Wed* Thur. Fri. Sat. Sun* Total Hours From To 2. Date available to start work // 3. If hired do you have a reliable means of transportation Yes No 4. Are you employed now May we inquire of your employer 5. Do you have any problems lifting 25 pounds If yes please explain why LIST MOST RECENT WORK EXPERIENCE Dates Name Address of Rate of Supervisors Name From/To Employer Pay Title Reason for Leaving AUTHORIZATION TO WORK STATEMENT If hired Federal law requires that you furnish documentation showing your identity and that you are legally authorized to work in the United States. Speak to one of the managers to see what forms of identification will satisfy the work authorization requirements. This identificiation must be presented to the manager the day you begin orientaiton* NO EMPLOYMENT CONTRACT AT WILL No employment contract is intended or created by statements made during the hiring process. It is understood that this employment is AT WILL and may be terminated at any time by either employer or employee. APPLICANT SIGNATURE In order to comply with Utah s Private Employer Verification Act Sizzling Platter will verify the social security number of ALL new hires in Utah through the Social Security Number Verification System* Legal Document No Changes Allowed 9/1/2011. List friends or relatives employed by this company Yes No 5. Have you ever worked for SPLLC Sizzler Red Robin Ruby River Hoppers Little Caesars before If so when 6. Utah Only Have you ever been convicted of a felony or a crime of moral turpitude Moral turpitude may be defined as any criminal conviction involving theft assault physical injury or the use or distribution of a controlled substance. Utah Only Have you ever been convicted of a felony or a crime of moral turpitude Moral turpitude may be defined as any criminal conviction involving theft assault physical injury or the use or distribution of a controlled substance. POSITION APPLIED FOR 1. Jobs applied for Desired pay per hour. Hours Available Mon* Tues. Wed* Thur. POSITION APPLIED FOR 1. Jobs applied for Desired pay per hour. Hours Available Mon* Tues. Wed* Thur. Fri. Sat. Sun* Total Hours From To 2. Date available to start work // 3. If hired do you have a reliable means of transportation Yes No 4. Fri. Sat. Sun* Total Hours From To 2. Date available to start work // 3. If hired do you have a reliable means of transportation Yes No 4. Are you employed now May we inquire of your employer 5. Do you have any problems lifting 25 pounds If yes please explain why LIST MOST RECENT WORK EXPERIENCE Dates Name Address of Rate of Supervisors Name From/To Employer Pay Title Reason for Leaving AUTHORIZATION TO WORK STATEMENT If hired Federal law requires that you furnish documentation showing your identity and that you are legally authorized to work in the United States.

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