Cracker Barrel Old Country Store¨
Background Verification
All applicants for employment by Cracker Barrel Old Country Store¨ must consent to background verifications. This form serves to provide necessary information in order to conduct the background verifications.Your accuracy and thoroughness will help expedite the processing of your application.
Please complete the following information. It is requested that you complete all information on this sheet even if it is already included on your application form or resume. Note: Date of birth and maiden name are not considered in the employment decision.This information is utilized for accurate records verifications only.
Please Print All Information
Your Name
SS#
Your Address
Daytime Telephone ( |
) |
Ñ |
Evening Telephone |
( |
) |
Ñ |
College |
|
|
|
|
|
|
|
Location |
|
|
|
Degree ❏ No ❏ 2 - Year |
❏ 4 - Year |
|
|
❏ Graduate Degree |
|
|
|
|
|
|
|
Last Mo./Yr.Attended |
|
|
Telephone |
( |
) |
Ñ |
Date of Birth |
/ |
/ |
|
Drivers License #: |
|
|
|
State |
|
|
|
Maiden Name or Other Name Used:
Year this name was last used:
I request that this document in its original or copied form serve as my valid authorization to any and all persons, educational institutions, past and/or current employers, organizations, credit reporting agencies, law enforcement or criminal record agencies, and other agencies to release information about me to a third party agency or its designated agent, and hereby release all persons, institutions, agencies, employers, and organizations providing such information from liability in any or all claims and damages connected with their providing any requested information.
Authorized by candidate:
Signature
Three Past/Current Employment Supervisors
Cracker Barrel Old Country Store, Inc. recruiter name
All references you list are subject to contact as part of our pre-employment process.
Please furnish current telephone numbers for references.
1. Name
Title
Company Address
Employment Dates
Your Position
Salary
2. Name
Title
|
Phone |
( |
) |
|
Ñ |
|
Company Name |
|
|
|
|
|
|
|
|
|
Company Address |
|
|
|
|
|
|
|
|
|
Employment Dates |
|
/ |
/ |
|
Your Position |
|
|
|
|
Salary |
|
|
|
|
3. Name |
|
|
|
|
|
Title |
|
|
|
|
|
Phone |
( |
) |
|
Ñ |
|
Company Name |
|
|
|
|
|
|
|
|
|
Company Address |
|
|
|
|
|
|
|
|
|
Employment Dates |
|
/ |
/ |
|
Your Position |
|
|
|
|
Salary |
|
|
|
|
Cracker Barrel Old Country Store¨
Background Verification Cont’d
Applicant Name
Please provide a list of cities, including state and zip, where you have lived or worked in the last seven (7) years. Use an extra sheet if necessary.
Please be sure all letters and numbers are legible.
Previous City
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Previous City |
|
|
|
State |
Zip |
Date |
/ |
/ |
Have you ever been convicted, entered a plea of no contest, had prosecution deferred, or adjudication withheld for any crime except for minor traffic violations? (Will only be considered in relation to specific job requirements.)
Y ______ N ______
If yes, please explain.