TELL US ABOUT YOURSELF Location you are applying for:(required) Select from Below Battlefield Blvd. F.S.U. BroadCreek Crossing F.S.U. Chesapeake Square Coliseum Mall Coliseum Drive F.S.U. General Booth Blvd. F.S.U. Greenbrier Mall Haygood F.S.U. Hilltop F.S.U. Indian River Road F.S.U. Kiln Creek F.S.U. Lynnhaven Mall Military Circle Mall Monticello Marketplace F.S.U. Patrick Henry Mall Pembroke Mall Portsmouth Blvd. F.S.U. Salem Crossing F.S.U. Va. Beach Blvd. D.T.O. Yoder Plaza F.S.U. Are you applying for: (required) Hourly  Management Last Name: (required) First Name: (required) Middle Initial: Present Address: (required) City: (required) State / Zip Code: (required) Select from Below Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    Home Phone: (required) Work Phone: E-mail: (required) In case of emergency, please notify: Name: Address: City: State / Zip Code: Select from Below Alabama Alaska Arizona Arkansas California Colorado Conneticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    Do you have a reliable means of transportation to work? Yes  No What wage are you expecting?  If you are younger than 18 years old, how old are you?   Social Security Number: Are you eligible to work in the U.S.? (PROOF OF ELEGIBLITY IS REQUIRED UPON EMPLOYMENT) Yes  No Have you ever been convicted of a felony? Yes  No AVAILABILITY Mon Tue Wed Thur Fri Sat Mornings Afternoons Evenings Summer School year All year If mornings are you available to open as early as 5:30am? Yes  No If evenings are you available to close as late as 11:00pm? Yes  No Minimum number of hours needed to work   Maximum number of hours needed to work PREVIOUS EMPLOYMENT HISTORY PLEASE LIST YOUR THREE MOST RECENT JOBS (including babysitting, lawn care or volunteer work): Have you ever worked for Chick-fil-A before? Yes  No If YES, which unit?  Employed From To Name of Employer Employer Address City State Zip Phone # Supervisor Earnings Reason for Leaving Employed From To Name of Employer Employer Address City State Zip Phone # Supervisor Earnings Reason for Leaving Employed From To Name of Employer Employer Address City State Zip Phone # Supervisor Earnings Reason for Leaving Job skills acquired: Job skills acquired: EDUCATION High School (last attended): Location: Did you graduate? Yes  No College/Vocational School: Location: Did you graduate? Yes  No If YES, degree and major: Grade point average: PERSONAL BACKGROUND What are your interests and activities? Please list awards and/or leadership positions held (work or school): MILITARY SERVICE Branch Rank Start Date End Date Duties: WHY DO YOU WISH TO BE EMPLOYED BY US? Please list your thoughts. (required) RESUME Paste your resume below if you have one. PERSONAL REFERENCES PLEASE PROVIDE FOUR REFERENCES TO WHOM YOU HAVE BEEN ACCOUNTABLE. PLEASE INCLUDE NO MORE THAN TWO FAMILY MEMBERS. Name Address Phone Relation Years Known Name Address Phone Relation Years Known Name Address Phone Relation Years Known Name Address Phone Relation Years Known I understand that completion of this application does not indicate that there are any positions currently open and does not obligate Chick-fil-A to hire me. I certify that all of the answers in this application are true and complete to the best of my knowledge and are subject to confirmation by Chick-fil-A. Chick-fil-A may make such investigations and inquires of my personal, employment, financial, academic history and other related matters as may be necessary in determining whether I can perform the essential functions of the position, which I seek. I hereby release past employers, schools, and all persons contacted from all liability in responding to inquiries in connection with my application. If I am employed, I understand that false or misleading information given in my application and/or interview(s) may result in termination. I understand that I am required to abide by all employer rules and regulations.

Chick-fil-A, Inc. is an equal opportunity employer and considers all applicants equally without regard to race, sex, age, religion, national origin, color, disability, citizenship, or veteran status.

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