Black-eyed Pea Web Application

All qualified applicants for employment receive consideration for employment without regard to race, color, religious affiliation, sex, national origin, age, sexual orientation, gender variance, marital status, veteran status, disability, or any other status protected by applicable law or regulation.

This application is valid for 60 days.

The Black-eyed Pea Restaurants reserves the right to assign any employee to any geographically proximate work site. This decision is based solely on the operational needs of Black-eyed Pea Restaurants.

Today's Date: Thursday, September 9, 2010

Personal Information

Last Name

First Name

Middle Name

Phone

Address

City

State

ZIP

E-mail

Are you at least 16 yrs. of age?

Are you of the legal age to serve alcohol?

Do you have a legal right to work in the United States?

Have you ever been employed by The Black-eyed Pea Restaurants?

Bep restaurant

Employed from

Employed to

Have you ever been convicted of a felony?

If yes, please provide details:

A positive response is not an automatic bar to employment with Black-eyed Pea Restaurants.

Miscellaneous

Please specify how you found out about our company

Employee Interests / Skills

Position applying for

Salary desired

Date available

Desired work schedule

Are you willing to work overtime?

Can you work a flexible schedule?

If no, please note your schedule restrictions

Calculator experience?

POS experience?

Education

School 1

High School, College Graduate, Business Vocational or Other Training

Location

State

Highest grade level

Diploma or degree type if earned

School 2

High School, College Graduate, Business Vocational or Other Training

Location

State

Highest grade level

Diploma or degree type if earned

Employment History

Please list all jobs, beginning with your present or last employer. Account for all periods, including unemployment, self-employment, and any military service. If space is insufficient, list on a separate page or additional application form.

Company 1

Company Name and Address

Employed from date

Employed to date

Salary start

Salary end

Hours worked per week

Job title

May we contact your previous employer

Supervisor (Name, Title and Telephone Number)

Duties and Responsibilities

Reason for leaving or wishing to leave

Company 2

Company Name and Address

Employed from date

Employed to date

Salary start

Salary end

Hours worked per week

Job title

May we contact your previous employer

Supervisor (Name, Title and Telephone Number)

Duties and Responsibilities

Reason for leaving or wishing to leave

Company 3

Company Name and Address

Employed from date

Employed to date

Salary start

Salary end

Hours worked per week

Job title

May we contact your previous employer

Supervisor (Name, Title and Telephone Number)

Duties and Responsibilities

Reason for leaving or wishing to leave

Company 4

Company Name and Address

Employed from date

Employed to date

Salary start

Salary end

Hours worked per week

Job title

May we contact your previous employer

Supervisor (Name, Title and Telephone Number)

Duties and Responsibilities

Reason for leaving or wishing to leave

Employment References

Reference 1

Name

Address

Telephone number

Occupation

Reference 2

Name

Address

Telephone number

Occupation

Reference 3

Name

Address

Telephone number

Occupation

Reference 4

Name

Address

Telephone number

Occupation

Essential Task Requirements for Employees

Cook

Can you walk at a rate of 0.5 miles per hour for up to 8 hours per day?

Are you able to lift 40 pounds from the floor to 44 inches up to 10 times per hour?

Can you read English or Spanish?

Can you reach and grip 20 pounds from 24-48 inches up to 200 times per hour?

Are you able to stand constantly for up to 8 hours?

Can you carry 40 pounds for a distance of 50 feet up to 5 times per hour?

Are you able to push/pull 40 pounds a distance of 2 feet up to 30 times per hour?

Quality Assurance Coordinator (QAC)

Can you walk at a rate of 0.5 miles per hour for up to 8 hours per day?

Can you reach and grip 3.5 pounds from 12-48 inches up to 125 times per hour?

Are you able to stand constantly for up to 8 hours?

Can you read English or Spanish?

Server

Can you walk at a rate of 1 mile per hour for up to 6-8 hours?

Are you able to lift 16 pounds from 31 inches to 42 inches for up to a minimum of 12-44 times per hour?

Are you able to stand constantly for up to 6-8 hours a day?

Can you read English or Spanish?

Are you 18 years of age or older?

Dishwasher

Can you walk at a rate of .25 mile per hour for up to 8 hours?

Are you able to lift 40 pounds from 35 inches to 52 inches up to 15 times per hour?

Can you reach and grip 2.5 pounds from 48 inches to 12 inches up to 125 times per hour?

Are you able to stand for up to 8 hours a day?

Can you carry 40 pounds for a distance of 40 inches up to 15 times per hour?

Are you able to push/pull 8 pounds up to 15 times per hour?

Do you have the manual dexterity to operate a blender?

Do you have the manual dexterity to operate a glass washer?

Greeter / Cashier (TX only)

Do you have the manual dexterity to operate a calculator?

Do you have the manual dexterity to operate a cash register?

Do you possess basic arithmetic skills (i.e., addition, subtraction, multiplication, division)?

Can you walk at a rate of 1 mile per hour for up to 8 hours per day?

Can you lift 15 pounds from 32 inches to 36 inches up to 10 times per hour?

Can you carry 15 pounds for a distance of 80 feet up to 10 times per hour?

Are you able to stand for up to 8 hours at a time?

Are you able to push/pull 21 pounds up to 2 times per hour (total body)?

Bartender

Can you walk at a rate of 0.25 mile per hour for up to 8 hours per day?

Are you able to lift 40 pounds from 7 inches to 41 inches up to 10 times per shift?

Can you reach and grip 1 pound from 63 inches to 33 inches up to 10 times per hour?

Are you able to stand constantly for up to 8 hours a day?

Can you read English or Spanish?

Can you carry 35 pounds for a distance of 50 feet up to once an hour?

Do you have the manual dexterity to operate a blender?

Do you have the manual dexterity to operate a glass washer?

Are you 21 years of age or older?

Busperson

Can you walk at a rate of 1 mile per hour for up to 8 hours per day?

Are you able to lift 40 pounds from 7 inches to 43 inches up to 20 times per hour?

Are you able to stand for up to 8 hours a day?

Can you carry 40 pounds for a distance of 100 feet up to 20 times an hour?

Do you have the manual dexterity to operate a tea machine?

Do you have the manual dexterity to operate a mop wringer?

Declaration

I certify the information set forth in this application for employment is true and complete to the best of my knowledge and belief and I agree you may investigate my statements. I understand that any information provided in this application found to be false will disqualify me from consideration for employment. I further understand that if after employed, any information provided on this application or provided in connection with my application for employment is found to be false, Black-eyed Pea Restaurants may terminate my employment and I acknowledge that under such circumstances, I shall have no cause of action or recourse against Black-eyed Pea Restaurants based thereon. I agree to permit all past employers to give to Black-eyed Pea Restaurants any information concerning me and release them, and Black-eyed Pea Restaurants, from any liability in furnishing or collecting such information. I understand that my employment and, if employed, my continued employment is conditioned upon my consent to and successful completion of a background / examination and agree to waive any and all claims against Black-eyed Pea Restaurants in connection with any background examination / investigation involving my application for employment and any subsequent employment. I understand that the scope of any background examination / investigation is dependent upon the position for which I apply. A background examination/investigation may include a seven (7) year criminal history, credit report, driving record, reference check, education and credential confirmation, and other background information as permitted pursuant to the Fair Credit Reporting Act, 15U.S.C. SS 1681, et. seq., and any applicable state Credit Reporting Acts/statutes/laws. I agree that it I am employed by Black-eyed Pea Restaurants, my employment is "at-will", meaning that it is at the will of either party, that either Black-eyed Pea Restaurants or I may terminated my employment at any time, for any reason, with or without notice. I understand and acknowledge that nothing contained in this application, nor any statements made by Black-eyed Pea Restaurants, its representatives, management or supervisors shall constitute any promise, guarantee or contract regarding employment. Notice: All offers of employment are contingent upon your production of proper documentation proving your eligibility to work within the United States.