This independent McDonald’s franchise is an equal opportunity employer
committed to a diverse and inclusive work force.
Name _____________________________________________________________ Number____________________________
First Middle Init. Last
Address _____________________________________________________________________ Phone ____________________
Street Apt./Suite# City State Zip
at this Previous How long
address?_____________ address ______________________________________________________________ there? ______
Position you are
applying for____________________ Location of restaurant you would like to work at ________________________
Date available Referred Do you have transportation
for work _________________________ by ________________________________________ to work? ❏ YES ❏ NO
Are you legally authorized to work Are you willing to transfer/
in the United States? ❏ YES ❏ NO relocate? ❏ YES ❏ NO
If so, geographic preference___________________________________________
Are you willing to Do you have a relative in
travel? ❏ YES ❏ NO the employ of McDonald’s?
❏ YES ❏ NO If yes, who? _______________________________________
Have you ever been If so, when Position held:
employed by McDonald’s and where last ❏ Crew ❏ Staff
before? ❏ YES ❏ NO employed?______________________________________ ❏ Management
School Name, City and State (Yes/No) Degree/Courses G.P.A.
©2004 McDonald’s Corporation CS-5066 U.S. Rev. 1/04 (Licensee)
Hiring Manager: Detach and file separately
This independently owned and operated McDonald’s organization is an equal opportunity employer committed to a diverse work
force. In order to assist us in our efforts, we invite you to voluntarily provide responses to the following requests for information.
Failure to respond will not subject you to adverse treatment. This form shall be kept confidential and will not be retained with your
application. Information provided will be used only in accordance with the law and for equal opportunity purposes.
❏ Male ❏ American Indian (1) ❏ White (4)
❏ Female ❏ Hispanic (2) ❏ Black (5)
❏ Asian American (3)