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Employment Application

Step 1 of 11

9%

Contact Info
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*

Employment Info
Position(s) of interest?*
- Line Cook
- Prep Cook
- Cold Prep
- Hot Prep
- Dishwasher
- Bakery
- Banquet Server
- Bartender
Date you can start?*
MM slash DD slash YYYY
Salary desired?*
Are you currently employed?*
- Yes
- No
If yes, where?*
How did you hear about us?*
Have you ever applied to this company before?*
- Yes
- No
When did you apply?*
MM slash DD slash YYYY
Where did you apply?*
Have you ever worked for this company before?*
- Yes
- No
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Where did you work?*
Have you ever worked under another name?*
- Yes
- No
If yes, please list*
First Last

Education History
Did you attend High School?*
- Yes
- No
Did you attend Trade School?*
- Yes
- No
Did you attend College?*
- Yes
- No
Do you have previous employment history?*
- Yes
- No

High School
High School Name*
High School Address*
Street Address City State ZIP Code
Years Attended?*
Did you graduate?*
- Yes
- No
Subjects of Study

Trade School
Trade School Name*
Trade School Address*
Street Address City State ZIP Code
Years Attended?*
Did you graduate?*
- Yes
- No
Subjects of Study

College
College Name*
College Address*
Street Address City State ZIP Code
Years Attended*
Did you graduate?*
- Yes
- No
Subjects of Study

Former Employer 1
Employer Name
Employer's Address*
Street Address City State ZIP Code
Date Started*
MM slash DD slash YYYY
Date Ended*
MM slash DD slash YYYY
Position*
Reason for leaving?*
May we contact this employer?*
- Yes
- No
If no, please list why?*
Do you need to list a 2nd employer?*
- Yes
- No

Former Employer 2
Employer Name*
Employer's Address*
Street Address City State ZIP Code
Date Started*
MM slash DD slash YYYY
Date Ended*
MM slash DD slash YYYY
Position*
Reason for leaving?*
May we contact this employer?*
- Yes
- No
If no, please list why?*
Do you need to list a 3rd employer?*
- Yes
- No

Former Employer 3
Employer Name*
Employer's Address*
Street Address City State ZIP Code
Date Started*
MM slash DD slash YYYY
Date Ended*
MM slash DD slash YYYY
Position*
Reason for leaving?*
May we contact this employer?*
- Yes
- No
If no, please list why?*

Occupational Qualifications
Date of birth*
MM slash DD slash YYYY
Sex*
- Male
- Female
Are you a U.S. Citizen?*
- Yes
- No
If an alien, do you have the right to be in the U.S.?*
- Yes
- No
If an alien, do you have the right to accept employment in the U.S.?*
- Yes
- No
Martial Status*
- Single
- Married
Do you have any physical condition(s) which might limit your ability to perform the job which you are applying for?
Do you have a reliable means to get to and from work?*
- Yes
- No
Do you have any relatives currently working for the company?*
- Yes
- No
Name*
First Last
Relationship*
I can work...*
- Full Time
- Part Time
- Temporary
- Permanent
- Weekends
- Holidays
- Overtime
- Split Shifts
- Days
- Nights

AUTHORIZATION
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by Americans with Disabilities Act (ADA) and other relevant federal and state laws."
I agree to the information stated above*
- Agree
- Disagree

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