Employment Personal Information Employment application Hot Harry's Location * Choose your location37 North Street, Pittsfield, MA724 Tyler Street, Pittsfield, MA403 Main Street,Dalton, MA596 Columbia Tpke, East Greenbush, NY Name * First Middle Last * Last Are you a US Citizen? Yes No If no, what country? 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Best Phone Number to reach you Home Phone Cell Phone Fax Email * Education High School (Highest grade or degree attained) Junior College/Tech (Highest grade or degree attained) College (Highest grade or degree attained) General Information Why do you desire to join the Hot Harry's Burritos team? How did you hear about Hot Harry's Burritos? Previous Employment information Name of Company/Employer Type of Business Position: Years Employed: Pay Rate: Name of Company/Employer Type of Business Position Years Employed: Pay Rate: Name of Company/Employer Type of Business Position Years Employed: Pay Rate: References (Please complete all three entries.) Name* * Relation of this person to you* * Years you have known this person* * Phone Number and Area Code* * Name Relation of this person to you Years you have known this person Phone Number and Area Code Name Relation of this person to you Years you have known this person Phone Number and Area Code Terms & Conditions I hereby release Hot Harry's Burritos, its representatives, and their officers, agents, employees and servants from any liability arising from or relating to the preparation of this report or investigation relating thereto. This authorization for release of information includes but is not limited to matters of opinion relating to my character, ability, reputation and past performance. I authorize all persons, schools, companies, corporations, financial institutions, credit agencies and bureaus, courts, and law enforcement agencies to release such information without restriction or qualification to Hot Harry's Burritos, its representative, or any of their officers, agents, employees and servants. I voluntarily waive all recourse and release them from liability fro complying with this authorization, and I hereby release Hot Harry's Burritos, and its representatives, and their officers, agents, employees, and servants, from any liability on account of the provision of such information or the use of such information in connection with this application. This authorization/release shall apply to this as well as any future request for an investigative consumer report by Hot Harry's Burritos I authorize that a photocopy or facsimile of this release be considered as valid as the original. I have read this application and everything I have stated in it is true. 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