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Employment Application
Name: Phone: E-Mail: SSN#:
Address: City: State: Zip Code:
How long have you lived at above address?:   
Are You 18 years or older?   Yes No If not, state date of birth  
If under age 18, how many hours per week are you employed elsewhere?     hrs.
Have you had any name changes this employer should know about in order to verify job or education history? Yes No Previous Name:
Do you have transportation to and from work? Yes No Are you authorized to work in the U.S.? Yes No
Position Applied For: Date You Can Start: Salary Desired:
Are you applying for:    Full Time   Part Time   Temporary   Days Only   Nights Only   Days/Nights  
Who recommended you for this position?   
Education
Schooling Name And Address Of School Grade or Degree
Completed		 Graduated?
High School Yes No
College or University Yes No
Others (Specify) Yes No
Military Service Schools Attended Yes No
Military Service Record
War Veteran Branch From: (Date)
Yes No
To: (Date)
Highest Grade
Please Check The Kind Of Work You Have Done:
  Bartender Cook Dishwasher Manager Salad Wait Staff
  Bookkeeper Cook Helper Food Prep Technician Pantry Sandwiches Wait Staff - Arm Service
  Bus Person Counter Fountain Pastry Cook Stenographer Wait Staff - Tray Service
  Carver Cashier Host or Hostess Porter Typist  
  Chef Dietitian Kitchen Helper Pot Washer Vegetable Cook None
Previous Restaurant Experience
(List Below Your Last Four Employers, Starting With Most Recent One First)
Company Name #1: Phone: Company Business: Your Position:
Address: City: State: Zip Code:
Immediate Supervisor: Title: Date Started: Salary Start:
Reason For Leaving : Date Ended: Salary End:
Company Name #2: Phone: Company Business: Your Position:
Address: City: State: Zip Code:
Immediate Supervisor: Title: Date Started: Salary Start:
Reason For Leaving : Date Ended: Salary End:
Company Name #3: Phone: Company Business: Your Position:
Address: City: State: Zip Code:
Immediate Supervisor: Title: Date Started: Salary Start:
Reason For Leaving : Date Ended: Salary End:
Company Name #4: Phone: Company Business: Your Position:
Address: City: State: Zip Code:
Immediate Supervisor: Title: Date Started: Salary Start:
Reason For Leaving : Date Ended: Salary End:
Are there any job duties that you would be unable to perform?
Is there anything we could do to accommodate you so you could perform all the required job duties?
Have you ever applied to this company before? Yes No If yes, where? When?
Are you employed now? Yes No Telephone    
In Case of Emergency Notify - (Name, Address, Phone) Relationship, If Any
  1. I authorize investigation of all statements contained in this application.
  2. I understand that misrepresentation or omission of facts called for is cause for dismissal and that my employment is substantially dependent on truthful answers to the foregoing inquiries.
  3. I have read these statements and answers to these inquiries. Yes No
Date Signature

 

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