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My signature on this form is proof that I have authorized the management of Earls Restaurant Ltd. or an agent acting on its behalf to collect use and disclose my personal information as contained on this form for purposes of verifying this information and assessing my suitability for employment. This consent is valid for the time for the review of my job application and in the event I am hired for the duration of my employment. I understand the omissions or misrepresentations made on this application or other documentation and / or tests related to employment will be sufficient cause for cancellation of my application and if employed for termina- tion from Earls. My signature on this form is proof that I have authorized the management of Earls Restaurant Ltd. or an agent acting on its behalf to collect use and disclose my personal information as contained on this form for purposes of verifying this information and assessing my suitability for employment. application for employment date of application mm / dd / yy Name Address City Postal Code Phone Email Address How long at present address Previous Address I was referred to this company by school Were you ever employed by Earls before YES Are you bondable YES walk in NO employee friend Are you legally entitled to serve alcohol YES position availability Job desired Availability please check mon tues wed thurs fri sat sun day night When can you start education training 1. Name of School Course Dates of Study From - To Did you Graduate/complete the program social media ad please complete reverse side agency work history 1. Employer Position Held From To Duties Reason for Leaving Rate I certify that the information provided in this application and supporting materials provided by me is true and com- plete. I understand the omissions or misrepresentations made on this application or other documentation and / or tests related to employment will be sufficient cause for cancellation of my application and if employed for termina- tion from Earls. My signature on this form is proof that I have authorized the management of Earls Restaurant Ltd. or an agent acting on its behalf to collect use and disclose my personal information as contained on this form for purposes of verifying this information and assessing my suitability for employment. This consent is valid for the time for the review of my job application and in the event I am hired for the duration of my employment. I understand that this consent itself may be provided to other organizations in the course of considering references as proof that I have consented to the collection of my personal information for these purposes. I understand that -If I am hired by Earls Earls will administer my employee personal information pursuant to its Privacy Policy a copy of which will be provided to me in my orientation package -Part of the application process includes a written examination and that I may be invited by Earls to attend at my discretion training classes which would assist me in preparing for the written examination* position will be reviewed Signature of Employee Date Earls thanks all applicants for their interest.

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