1-New Hire Folder Checklist.xls

Dairy Queen

Employment Application

An Equal Opportunity Employer

It is our policy to comply with all applicable state and federal laws prohibiting discrimination based on race, age, color, sex, religion, national origin, or other protected

classifications.

Treat yourself to a Great Job

Join a winning Team!!!

This application is for employment at an independently owned and operated franchise restaurant.

This is not for employment with the franchisor, American Dairy Queen Corp.

PERSONAL

PLEASE PRINT CLEARLY Date _________________

Name (Please Print) Last First Middle Social Security Number

Mailing Address

(Number & Street)

(City, State, & Zip Code)

Phone Number

( )

Permanent Address

(Number & Street)

(City, State, & Zip Code)

Alternate Phone Number

( )

Are you willing to travel for the job?

DL No. State Issued Exp. Date

Are you of the leagal age of 18? Yes No

If not, age

Have you ever been convicted of a felony in the last seven years? Yes No

If you answered yes, please explain:

Have you ever served in the Us. Military? Yes No

If yes please provide the following information: Branch of Service: Rank at time of separation:

I served from: to Were you dishonorably discharged? Yes No

EMPLOYMENT INFORMATION

Are you seeking:

Temporary Full-time

Part-time

What position are you applying for? Are you willing to work overtime? Weekends? Holidays?

Sales Kitchen Management Other Yes No Yes No Yes No

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

NOTE: All applicants are hired on a part time basis

Are you currently employed?

Yes No

If hired, when would you be able to start?

Have you ever worked for this organization before? Yes

If yes, name used:

Who referred you to this job?

List any friends or relatives employed by this Do you have a Food Handler Permit?

DQ Employee Other company: Yes No

Name: If answer is no, you will be required to get one.

Have you ever been discharged or asked to resign for any position?

Yes No If yes, please describe:

Please refer to the job descriptions for the position for which you are applying. Are you able to perform all the tasks as outlined on

the job descriptions with or without reasonable accomodation? Yes

Please describe which tasks, if any, you will

need an accomodation to perform, and explain what type of accomodation you will need:

Shift & Hours Available

Day Shift

Night Shift

EDUCATION (Please circle highest level attained)

1 2 3 4 5 6 7 8 9 10 11 12 G.E.D. 1 2 3 4 5 6 7 8

Name of School: Name of School: Name of School:

Location of School: Location of School: Location of School:

If currently in High School, are you enrolled in a recognized Co-op program? Yes No

Degree and Major:

If yes, identify program and school: Minor:

College

Elementary Secondary

EMPLOYMENT HISTORY

Company Address City State Zip Telephone Number

( )

Date Hired: Date Separated: Your Job Title Supervisor's Name and Title

Mo. Yr. Mo. Yr.

Salary: Beginning: $ Ending: $

Describe Nature of Duties:

Specific reason for leaving: If currently employed, may we contact your

employer? Yes No

Company Address City State Zip Telephone Number

( )

Date Hired: Date Separated: Your Job Title Supervisor's Name and Title

Mo. Yr. Mo. Yr.

Salary: Beginning: $ Ending: $

Describe Nature of Duties:

Specific reason for leaving: If currently employed, may we contact your

employer? Yes No

Company Address City State Zip Telephone Number

( )

Date Hired: Date Separated: Your Job Title Supervisor's Name and Title

Mo. Yr. Mo. Yr.

Salary: Beginning: $ Ending: $

Describe Nature of Duties:

Specific reason for leaving: If currently employed, may we contact your

employer? Yes No

This application does not create any employment agreement (either express or implied), nor it is intended to create any enforceable obligations on the part of

Lynn Lee Inc or its employees except as specified in this application.

Do you understand? Yes___ No_____ Initials: Dir____ App_____

I certify that all of the information I provided in this application is true and complete. I understand that misrepresentation or omission of facts in this

application, in any supplement to it, or in any other corporate record will be sufficient grounds for not employing me, or will be cause for dismissal without

notice at any time during my employment. Do you understand? Yes___ No_____ Initials: Dir____ App_____

I understand that part of the processing of my application may involve routine inquiring pertaining to my background and qualifications and that information

on the nature and scope of such inquiry, if one is made, is available to me upon request. I authorize the schools and prior employers listed in this employment

application (except where specifically withheld in this application) to provide my record, reason for leaving, and all other information they may have

concerning me, and I release all parties from any and all liability or claims for damage whatsoever that may result from the inquiry and release of information.

Do you understand? Yes___ No_____ Initials: Dir____ App _____

I understand that Lynn Lee is a drug-free workplace and that if employed by Lynn Lee, I will abide by the provisions of the Lynn Lee’s drug and alcohol

abuse policy. Under the circumstances described in such policy, I agree to: the collection of specimens of my urine/breath or hair to detect the presence of

drugs and/or alcohol, the submission of such specimens to a laboratory designated by Lynn Lee; the analysis of such specimens for drugs and/or alcohol; and

the release of test results from the analysis to Employees authorized representatives.

Do you understand? Yes___ No_____ Initials: Dir____ App_____

I understand that nothing contained in this application or in the granting of an interview is intend to create an employment contact between the restaurant

owner and myself for either employment or for the providing of any benefits. No promises regarding employment have been made to me, and I understand

that no such promise or guarantee is binding upon the restaurant owner unless expressly made in a written contract or employment signed by me and an

authorized representative of the restaurant owner.

Do you understand? Yes___ No_____ Initials: Dir____ App_____

I understand that Lynn Lee Inc Dairy Queens does not offer Worker’s Comp. Initials: Dir____ App_____

If employed, I agree to follow all of Employers policies and procedures. Initials: Dir____ App_____

I HAVE READ THE ABOVE PARAGRAPHS, UNDERSTAND THEIR IMPORTANCE AND EFFECT UPON MY EMPLOYMENT, AND ACCEPT THE

SAME AS CONDITIONS OF MY EMPLOYMENT WITH LYNN LEE INC DAIRY QUEEN.

Applicant’s Signature: Date:

Director’s Signature: Date:

ATTENTION: READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SIGNING THIS APPLICATION FOR EMPLOYMENT

***If you do not have a bank account at all or do not have all of your bank account information available to

complete the direct deposit form, then you must complete this form to be enrolled in the Payroll Card***

Employee Signature _______________________ Date _____________

Dairy Queen

BBVA Compass PaySource Card

Acknowledgement Form

The Company gives Team Members two options to receive funds for their pay, direct

deposit into a Team Member’s bank account or funding through a BBVA Compass PaySource

Visa Card, or “Payroll Card”. Team Members that prefer direct deposit must complete and sign

the Employee Direct Deposit Form. If an employee does not choose the direct deposit option, or

a direct deposit form is not submitted in a timely fashion, The Company will provide an

Temporary “Payroll Card” to which it will electronically credit the Team Member’s net pay.

After 2 consecutive deposits on the Temporary “Payroll Card”, you will receive the permanent to

your mailing address.

First Name ____________________MI _______ Last Name __________________________

Social Security Number _ _ _ / _ _ / _ _ _ _ Date of Birth (mm/dd/yyyy) _ _ / _ _ / _ _ _ _

Address _______________________________________________ Apt # _________________

City __________________________________ State ________ Zip Code _________________

Home Telephone ________________________ Work Telephone _______________________

Email ________________________________________________________________________

Please read and sign before submitting: I understand and acknowledge that “The Company”

will be electronically crediting my net pay into my BBVA Compass PaySource Visa Card for me

to access and for the purpose of paycheck direct deposit and, if necessary, debit entries and/or

adjustments for any credit entries made in error. I understand that all fees associated with BBVA

Compass PaySource Visa Card originate from BBVA Compass and not, “The Company”.

Policies and procedures regarding the “Payroll Card” may change or be altered at any time by

“The Company”. This acknowledgement will remain in effect during the time I am employed by

“The Company” and receiving pay, unless I initiate the direct deposit option.

Compass PaySource

Card

The Easy Way to Deliver Your Pay

Help your business reduce costs and increase employee satisfaction at the same time! The Compass

PaySource Card allows you to deliver your employees’ pay, bonuses, reimbursements, and other types of

compensation easily. Instead of writing checks, you electronically deposit their pay to the Compass

PaySource Card. Your employees don’t even need a bank account.

Service Advantages

For your Employees

• Provides the ability to use the Compass PaySource Card for purchases anywhere Visa® Check Cards are

accepted

• Allows employees to get cash at any banking center that processes Visa cash advances and at any ATM

displaying the Visa/PLUS® sign worldwide

• Supports surcharge-free ATM transactions at over 43,000 All-point Network ATMs nationwide

• Eliminates the anxiety of checks lost in the mail

• Saves the time and inconvenience of leaving work to cash or deposit checks

• Allows employees access to their payroll funds at the beginning of the day on pay day

• Saves the employee money by eliminating check cashing fees

• Provides a safe alternative to carrying cash

• Provides optional text message alerts including daily available balance, low balance and value load alerts

• Allows employees to access balance and transaction information online or by calling a toll-free number

BBVA Compass is a trade name of Compass Bank, a member

Rev. 05/14 of the BBVA Group. Compass Bank, Member FDIC.

Employee Direct Deposit Enrollment Form

Payroll Manager - Please complete this section and send a copy to ADP for enrollment. (Please print.)

Company Code: 9N7 Company Name: Dairy Queen Date: ____________________

Payroll Mgr. Name: Mary Leon Payroll Mgr. Signature: ________________________________

To enroll in Full Service Direct Deposit, simply fill out this form and give it to your payroll manager. Attach a voided check for each

checking account-not a deposit slip. If depositing to a savings account, ask your bank to give you the Routing/Transit Number for

your account. It isn't always the same as the number on a savings deposit slip. This will help ensure that you are paid correctly.

Important! Please read and sign before completing and submitting.

I hereby authorize my employer (hereinafter "Company") to deposit any amounts owed me by initiating credit entries to my accounts

at the financial institutions (hereinafter "Bank") indicated on this form. Further, I authorize Bank to accept and to credit any credit

entries indicated by Company to my accounts. In the event that Company deposits funds erroneously into my account I authorize

Company to debit my account for an amount not to exceed the original of the erroneous credit.

This authorization is to remain in full force and effect until Company and Bank have received written notice from me of its

termination in such time and in such manner as to afford Company and Bank reasonable opportunity to act on it.

Employee Name: _________________________________ Social Security#: __ __ __-__ __-__ __ __ __

Employee Signature: _______________________________________ Date: ______________________________

_____ I will be receiving a Payroll Card. _____ I would like to terminate my Direct Deposit.

Account Information

The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form. Make sure to indicate

what kind of account, along with amount to be deposited if less than your total net paycheck.

1. Bank Name /City /State: _______________________________________________________________________________

Routing/Transit #: ___ ___ ___ ___ ___ ___ ___ ___ ___ Account Number: ________________________

[] Checking [] Savings [] other I wish to deposit: $ or [] Entire Net Amount

2. Bank Name /City /State: _______________________________________________________________________________

Routing/Transit #: ___ ___ ___ ___ ___ ___ ___ ___ ___ Account Number: ________________________

[] Checking [] Savings [] other I wish to deposit: $ or [] Entire Net Amount

3. Bank Name /City /State: _______________________________________________________________________________

Routing/Transit #: ___ ___ ___ ___ ___ ___ ___ ___ ___ Account Number: ________________________

[] Checking [] Savings [] other I wish to deposit: $ or [] Entire Net Amount

ATTENTION PAYROLL MANAGER:

Employers must keep ordinal employee enrollment form on file as long as the employee is using FSDD, and for two years

thereafter.

Dairy Queen

Team Member Job Description

Acknowledgement

Dairy Queen requires that each applicant be informed of what is expected of Team

Members in each position with the Company. In return, the Company expects that

applicants will truthfully state whether or not they can perform the requirement for each

job.

Please read the Job Descriptions carefully to determine whether you can perform the jobs.

If so, please sign and date this notice and return it to the Director with your employment

application to be kept on file at the Dairy Queen office.

By accepting your statement that you can perform, the job for which you have applied,

the Company does not waive the right, in the event that you are employed, to discharge

you at any time, for any reason, with or without notice, with or without cause.

I _____________________________________ , have been provided a copy of the Job

Description for my review. I hereby certify that I have read and understand the Job

Descriptions and that I can perform all aspects of the job as required by Dairy Queen.

I _________________________________, have been provided a copy of the Job

Description for my review. I hereby certify that I have read and understand the Job

Descriptions and that I cannot perform each and every function of the Job Description.

To the extent that you cannot perform each function, you must state below which

requirements cannot be met and why:

_____________________________________________________________

I understand that the Company has a right to expect Team Members to perform all

aspects of a position and if you are unable to perform these function, you may not be

hired, or you may be released from employment. By accepting your statement of which

functions cannot be performed, the Company does not waive any job requirements or

indicate that you will be offered a position but will be excused from performance of those

requirements.

________________________________ _________________

Applicant Signature Date

_________________________________ __________________

Directors Signature Date

Dairy Queen

Uniform Acknowledgement Form

I understand that the uniforms and other items described below are for my use while employed with the company.

During my employment, I will maintain all uniform items in a clean and usable condition as described in our

company handbook and uniform policy. I understand that the company will provide, at no cost, the following

uniform items:

1 - Approved Dairy Queen Shirt, Cap or Visor, Apron and Name Tag all of which I must wear while at work.

All uniform items listed above that are provided by the company must be returned in the event of resignation or

termination. I understand that any additional uniform purchases beyond what is provided by the company is

completely voluntary and not a condition of employment or continued employment. I permit the company to

deduct any money owed for additional uniform purchases from my paycheck in two equal amounts over two pay

periods. I further authorize the company to deduct the total of any money owed for additional uniforms or shoes

from my final paycheck in the event of termination or resignation. Items that I may have purchased at my own

discretion are mine to keep.

I understand that non-slip shoes are a condition of initial and continued employment with the company. I

understand that I am allowed to purchase any brand of non-slip shoes so long as it is a certified non-slip shoe. The

company, however, puts a high priority on my safety and that of its team members and strongly recommends

Shoes for Crews as the preferred non-slip shoe choice. As a new team member, I have the option of purchasing

Shoes for Crews through the company account and have the money owed for the purchase deducted from my

paycheck in two equal amounts over two pay periods. The company will contribute $15 (fifteen dollars) or the

equivalent of more than ½ the price of the basic shoe offered through Shoes for Crews. I understand that this is an

option provided to me as a new team member as a convenience, and incentive for using the Shoes for Crews

brand. I further understand that I am free to select a different style of Shoes for Crews at my discretion, but the

company does not require this and me doing so is being done voluntarily. I completely understand that Team

members will not be allowed to work if we do not have Shoes for Crews or a certified type of non-slip shoe.

Please complete the information below

Your understanding and acknowledgement of our company’s uniform policies is greatly appreciated and we are

very excited to welcome you to Team DQ.

My signature below is confirmation that I understand the uniform and non-slip shoe policy.

Team Member Signature ________________________________________ Date ______________

My signature below is confirmation that I voluntarily want to purchase slip-resistant footwear from my employer’s

paid third party vendor (Shoes for Crews). My signature below further authorizes my employer to deduct (in two

equal payments) the price of the shoes I have selected, less $15.00 that the company has agreed to pay on my

behalf.

Team Member Signature ________________________________________ Date ______________

Director / Mgt. Signature ________________________________________ Date ______________

Dairy Queen

Team Member Children’s

Miracle Network Pledge Form

Restaurant Number:________________ Date:________/______/_____

Team Member Name: ____________________________________________________

Address: _______________________________________________________________

City: _______________________________ State:___________ Zip:_______________

For the benefit of the Driscoll Children’s Hospital, I Subscribe to the Children’s

Miracle Network as follows:

Payroll Deduction –Indicate amount to be deducted each payroll.

$ __________.________

Indicate date to begin deduction or leave blank for next payroll.

Date: ________/_________/_______

Payroll deduction will be made as indicated above until further notice is given by

you to the Dairy Queen Office. For more information contact your Area Supervisor

or the Dairy Queen Office at (956)787-8770.

______________________________ _________________

Team Member Signature Date

Each year Dairy Queen helps to raise monies for the hospitals that help needy

children. Our local children’s hospital is in Corpus Christi, Texas the Driscoll

Children’s Hospital. Your contribution will be greatly appreciated and will go

directly to the hospital.

Dairy Queen

Team Member Personal

Commitment Acknowledgement

A Personal Commitment to My Employer and Myself:

Integrity: The Ability to make a promise and keep it!

By agreeing to the following commitments, I am giving my personal promise to

uphold these Standards.



I promise to treat every Fan and Team Member as I wish to be treated, with the

utmost respect and courtesy.



I promise to promote goodwill to all customers and co-workers and to handle

customers concerns personally with the attitude that “the customer is always

right.”



I promise to practice productive job behavior, arrive at work on time, and follow

all rules, even when unsupervised.



I promise to do what needs to be done to the best of my ability.



I promise to uphold the standards and ethics the company has set for all its

Team Members in regard to respect for property and the use of illegal

substances.



I promise to follow and actively promote all safety rules and regulations.



I promise to uphold the company image in regard to my personal grooming

habits, dress and language.



I promise to follow all polices and procedures as outlined to me in the Team

Member handbook.



I promise to read, sign, post, and uphold the DQ Oath.

My Signature is as good as my word!

________________________________ _________________

Applicant Signature Date

Applicant’s First Name __________________________ Middle __________ Last _____________________________

SS# _______________________________________

I give _______________________________, permission to obtain the employment references necessary to make a hiring

decision and hold persons giving references free from any and all liability resulting from this process. I waive any provision

impeding the release of this information and agree to provide any information necessary for the release of this information

beyond that provided on the employment application and reference verification form.

_______________________________________ ____________________________________

Signature Date

Company Name Address Phone Number

From

Mo. & Yr.

( )

Job Title Reason for leaving Supervisor's Name and Title

Describe duties briefly: Starting Salary: Ending Salary:

Did you work any overtime? Yes No If yes, how often?

Were ever counseled about attendance or tardiness? Yes No If yes, how often?

Were you evaluated by your Supervisor? Yes

If yes, when was it?

Were there any comments made by your Supervisor at that time?

When we speak to your former Supervisor, we will ask him or her to rate your performance with regard to the following categories.

Please rate yourself in the following categories as feel he/she will rate you:

TEAMWORK:

The degree to which you are willing to work harmoniously with others; the extent to which you conform to the policies of

management.

Unsatisfactory Below Average Average Above Average Outstanding

DEPENDABILITY:

The extent to which you can be depended upon to be available for work and do it properly; the degree to which you

are reliable and trustworthy; the extent to which you are able to work scheduled days and times, as well as your willingness to work additional

hours if needed.

Unsatisfactory Below Average Average Above Average Outstanding

INITIATIVE:

The degree to which the employee acted independently in new situations: the extent to which he or she saw what needed to be

done and did it without being told: the degree to which the employee did his or her best to be a top employee.

Unsatisfactory Below Average Average Above Average Outstanding

QUALITY:

The degree to which the employee's work was free from errors and mistakes; the extent to which his or her work was accurate; the

quality of the employee's work in general.

Unsatisfactory Below Average Average Above Average Outstanding

CUSTOMER SERVICE:

The degree to which employee related to the customer's needs and/or concerns.

Unsatisfactory Below Average Average Above Average Outstanding

OVERALL PERFORMANCE:

The degree to which you were satisfied with the employees's efforts and achievements, as well as his or her

eligibility for rehire.

Unsatisfactory Below Average Average Above Average Outstanding

Did you resign from this position? Yes No Discharged? Yes No Laid-off? Yes No

Were ever disciplined on the job? Yes No Explain: _________________________________________________________

Applicant's Name: __________________________________________________

Date: ________________________________

Supervisor's Name: __________________________________________________ Title: ______________________________________

Company: ___________________________________ City/State: _________________________

Phone: ( ) ___________

TEAMWORK:

The degree to which you are willing to work harmoniously with others; the extent to which you conform to the policies of

management.

Unsatisfactory Below Average Average Above Average Outstanding

DEPENDABILITY:

The extent to which you can be depended upon to be available for work and do it properly; the degree to which you

are reliable and trustworthy; the extent to which you are able to work scheduled days and times, as well as your willingness to work additional

hours if needed.

Unsatisfactory Below Average Average Above Average Outstanding

INITIATIVE:

The degree to which the employee acted independently in new situations: the extent to which he or she saw what needed to be

done and did it without being told: the degree to which the employee did his or her best to be a top employee.

Unsatisfactory Below Average Average Above Average Outstanding

QUALITY:

The degree to which the employee's work was free from errors and mistakes; the extent to which his or her work was accurate; the

quality of the employee's work in general.

Unsatisfactory Below Average Average Above Average Outstanding

CUSTOMER SERVICE:

The degree to which employee related to the customer's needs and/or concerns.

Unsatisfactory Below Average Average Above Average Outstanding

OVERALL PERFORMANCE:

The degree to which you were satisfied with the employees's efforts and achievements, as well as his or her

eligibility for rehire.

Unsatisfactory Below Average Average Above Average Outstanding

Why did this employee leave your company? _______________________________________________________________________

Would you re-employ him or her? Yes No If no, why not? ___________________________________________________

Is there anything else we should know about this person? _____________________________________________________________

What were the dates of his/her employment with you? From: __________ To: _________ What were his or her earnings? _______

Supervision Requirements? ____________________________________________________________________________

Attendance? _______________________________________________________________________________________

Strenghts & Limitations? _____________________________________________________________________________________________

Job Performance? ___________________________________________________________________________________________________

Additional Comments: _______________________________________________________________________________________________

Dairy Queen

Team Member Store Information

Acknowledgement

Your Director:_____________________________________

Your Restaurant:___________________________________

Phone Number:_________________

Your Area Supervisor:______________________________

You are scheduled to go to Orientation on ___________________it will be

from___________ to ______________AM/PM it will be held at

______________________________________________.

You then will report back to me on _________________________at

_____________ AM/PM to start your Training as a ____________________.

Your starting pay will be $_________ per hour.

I acknowledge that it is my responsibility to fill out all necessary paper work

before I start my employment with Lynn Lee Inc.

I acknowledge that if there is any information missing I will provide it to the

Restaurant Director before I am scheduled for Orientation.

Furthermore I acknowledge and understand that if I do no comply with the

“New Hire” policies and procedures that I will not be issued a paycheck

until this information is supplied.

______________________________ _________________

Applicant Signature Date

_________________________________ __________________

Directors Signature Date

Classification of Employment

Change Form

All Team Members are hired under the classification of Regular Part-Time Employees, Non-exempt.

You have been hired under this classification of employment. The completed document below serves

to change your classification of employment as indicated. The Team Member Handbook as well as the

Classification of Employment and Benefit Description Policy describe important information about

your employment with the company. Please refer to them for a complete explanation of employment

classifications as well as the specific benefits that are applicable to your newly indicated classification.

Your signature below acknowledges your understanding of the above mentioned company policies and

your willingness to comply with the said policies.

If you should have any questions please consult with your immediate supervisor and/or the President of

the Company.

Your “Classification of Employment” is changed to: _____________________ / _______________

Regular Full-Time TM Exempt or Non-exempt

Temporary TM Exempt or Non-exempt

Effective date for reclassification: __________________

Your Supervisor is: __________________

Your rate of pay is: $_________________

________________________________ ______________________

Team Member Signature Date

________________________________

Team Member Printed Name

________________________________ ______________________

Immediate Supervisor Signature Date

________________________________ ______________________

President’s Signature Date

\llic classification of employment change . wps 04-04