Electronically signed and acknowledged by: Mark T Dzieman on 11/04/2021 00:00:57 [IP: 72.218.177.151] HRLY-AI6FAG4KTZHJ

Hourly Application

APPID: AI6FAG4KTZHJ

Unit Number: #1115 - 1811 W. MERCURY BLVD, HAMPTON, VA Applicant's Name: Mark T Dzieman Social Security#: 9440 Preferred Name: Mark Dzieman

Current Address: 231 Regent St Apt 4, Hampton, VA, 23669 Phone: 757-***-**** Email: ad2iru@r.postjobfree.com

Emergency Contact: Edward Dzieman 757-***-**** 5028 school rd Virginia Beach Virginia 23455 Are you legally eligible for employment in the US?: Yes Did someone recruit you to apply for a job at Waffle House?Not Available Have you ever been convicted of or pled guilty to one of the following crimes? (Murder, Rape, Child Molestation, Armed Robbery, Kidnapping)Yes Child Molestation or associated crimes Within the last 5 years, have you been convicted of or pled guilty to one of the following crimes?

(Robbery, Sexual Assault, Aggravated Assault, Aggravated Battery, Accessory to Murder or Other Felony)Yes Other Felony

Yes, felony I got diagnosed

Are you a Registered Sex Offender?: Yes

Showing up on time for scheduled work is an essential job function. Do you have a reliable way to get to work? :Yes

The job for which you are applying for includes, but is not limited to, the following essential job functions: bending, lifting, stretching and standing on your feet for a full 7 - 10 hour shift. Can you do this with or without an accommodation?: Yes

Which shift(s) do you prefer?1

What position are you applying for? (you may select more than 1) Sales Associate (Server), Are there days of the week you are not regularly able to work? (Please only select those days that will be an ongoing conflict for you – please note that, while Hourly Associates are not required to work every weekend, they are required to be available to work Saturdays and Sundays).” Yes Tuesday/Wednesday/Thursday/Friday/

Are you willing to work shift work?: Yes

Electronically signed and acknowledged by: Mark T Dzieman on 11/04/2021 00:00:57 [IP: 72.218.177.151] HRLY-AI6FAG4KTZHJ

How many hours are you committing to work weekly?: 8 hours Were you previously employed by Waffle House?: No

Positive attitude and focus on motivation to working to due success stability to earn respect Do you have any friends or family who currently work for Waffle House?: Yes White woman I ever met last 2016 to 2020 in Hampton Virginia at Waffle House Have you worked in a previous job that required regular customer service?: Yes I leave eggleston job from Norfolk Virginia

Why do you want to work for Waffle House?

I want to work stocker and janitor and clean

Electronically signed and acknowledged by: Mark T Dzieman on 11/04/2021 00:00:57 [IP: 72.218.177.151] HRLY-AI6FAG4KTZHJ

Record Of Education (High School)

High School Name 1: Ocean lakes high school

Did you graduate?: Yes

High School Name 2:

Did you graduate?:

Record Of Education (College)

College Name 1: GED

Did you graduate?: Yes

College Name 2:

Did you graduate?:

College Name 3:

Did you graduate?:

Record Of Employment

Name of Employer:

Address:

Type of Business:

Phone:

Worked From - To: -

Work Detail:

Starting Rate - End Rate: -

Name of Supervisor:

May we contact your former employer?:

Name of Employer 2:

Address:

Type of Business:

Phone:

Worked From - To: -

Work Detail:

Starting Rate - End Rate: -

Name of Supervisor:

May we contact your former employer?:

Name of Employer 3:

Address:

Type of Business:

Phone:

Worked From - To: -

Work Detail:

Starting Rate - End Rate: -

Name of Supervisor:

May we contact your former employer?:

Other Experiences and Skills: Experience wash machine and fold and wash plates and clean restrooms and janitor and fold clothes and clean tables and wash car Available to Work: 2021-11-16

Electronically signed and acknowledged by: Mark T Dzieman on 11/04/2021 00:00:57 [IP: 72.218.177.151] HRLY-AI6FAG4KTZHJ

References

Personal/Professional Reference 1:

Personal/Professional Reference 2:

Personal/Professional Reference 3:

Electronically signed and acknowledged by: Mark T Dzieman on 11/04/2021 00:00:57 [IP: 72.218.177.151] HRLY-AI6FAG4KTZHJ

Consent for Credit and Background Information

Dear Applicant or Employee:

Please Read the Following

PLEASE TAKE NOTICE THAT WAFFLE HOUSE MAY OBTAIN A BACKGROUND CHECK ON YOU FOR EMPLOYMENT PURPOSES

Waffle House, Inc. or one of its subsidiaries or affiliates (“Waffle House”) may obtain a background check on you, often referred to as a consumer report, for employment purposes, including a criminal records search. A consumer report under the Fair Credit Reporting Act is defined as any written, oral, or other communication of any information by a consumer reporting agency bearing on a consumer’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, which is used or expected to be used, or collected in whole or in part, for the purpose of serving as a factor in establishing the consumer’s eligibility for, among other things, employment purposes.

Authorization

By signing below, I agree that I have carefully read the above notice and I consent to the procurement of a background check report, often referred to as a consumer report, for employment purposes. I also acknowledge that, to the extent Waffle House hires me, this authorization shall remain in effect throughout my employment, with no need to request a subsequent authorization.

Applicant's Legal Name: Mark T Dzieman

Social Security#: 9440

Maiden or Other Names Used :

Current Address, Include City, State and Zip : 231 Regent St Apt 4 Other States Lived in: VA/

Citizen: Y

Contact this candidate