Employment Application

Personal Information
Name*
First Middle Last
Home Address*
Street Address City State Zip Code
Cell Phone*
Work Phone
May we contact you at work?
- Yes
- No
Email*
Position Applying For
Position Applying For*
Date Available*
MM slash DD slash YYYY
Are you interested in (check all that apply)*
- Full-Time
- Part-Time
Days and hours available.
Complete if applying for restaurant position.
Enter times (from – to) that you are available for each day below.
Enter NA if not available on that day.
Sunday*
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Are you willing to relocate?*
- Yes
- No
Are you 16 years or older?*
- Yes
- No
(No one under age 16 may be hired)

U.S. Military Service
Branch of Service
Technical Specialization
Rank Attained
Legal
Are you legally authorized to work in the United States?*
- Yes
- No
(Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act (IRCA) of 1986.)
Were you ever discharged by any company?*
- Yes
- No
If yes, give name of company(ies)
Name of company(ies) and reason for discharge

Employment History
List employment starting with your most recent position. You may include a description of verified work performed on a volunteer basis.
Is any additional information relative to a different name necessary to check your work record?*
- Yes
- No
If yes, explain:
Name of Employer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Address of Employer
Street Address City State Zip
Job Title
Supervisor
List Major Duties
Reason for Leaving
Name of Employer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Address of Employer
Street Address City State Zip
Job Title
Supervisor
List Major Duties
Reason for Leaving
Name of Employer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Address of Employer
Street Address City State Zip
Job Title
Supervisor
List Major Duties
Reason for Leaving
Name of Employer
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Address of Employer
Street Address City State Zip
Job Title
Supervisor
List Major Duties
Reason for Leaving
Have you previously worked for Dunkin' or any of its subsidiaries or Franchisees?*
- Yes
- No
Name
Location
Street Address City State Zip
Position Held
Supervisor
Dates Employed From
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Reason for Leaving

References
Name
Address
Street Address City State ZIP Code
Work Phone No.
Title
Years Known
Name
Address
Street Address City State ZIP Code
Work Phone No.
Title
Years Known
Name
Address
Street Address City State ZIP Code
Work Phone No.
Title
Years Known
Please Read Carefully
In the event of employment, I understand that false or misleading information given in my application or interview(s) may results in immediate Dismissal. I understand, also, that I am required to abide by all rules and regulations of the Franchise of Dunkin’.
Enter Your Initials*
I understand and agree that if employed, employment will be “AT WILL”. That is, either I or the employer may end the employment relationship at any time, for any reason, or for no reason with or without notice or cause. I understand that receipt of this application does not imply employment and the application or any other documents are not contracts of employment.
Enter Your Initials*
I understand that I am applying for work with (one or more) Dunkin’ Franchisees, and not Dunkin’ Brands, Inc. or any of its affiliates. If hired the Franchisee will be my only employer. Franchisees are independent businesses who set their own wage and benefit programs that can vary among Franchisees.
Enter Your Initials*
Applicants Signature
Enter Your Full Name as Your Electronic Signature*
Date Signed*
MM slash DD slash YYYY

Personal Information