PERSONAL INFORMATION

Date (required):

Full Name (required):

Phone (required):

Email (required):

Street Address (required):

City (required):

State (required):

Zip (required):

Rate of Pay Desired Per Hour (required):

Date Available to Work (required):

Full-Time or Part-Time (required):
Full-TimePart-Time

Number of Hours Desired a Week (required):

Shifts (required):
AM ShiftPM Shift

Hours Available to Work (required):

Can You Work Overtime (required):
YesNo

How were you referred to us for employment? (required):
Walk-InFriendAdOther

Position Applied For? Check all that apply (required):
BartenderServerCookSecurity

Do you have the ability to perform the essential function of the job for which you have applied? (required)
YesNo

Have you ever been convicted of a felony in the last seven years? (required):
YesNo

If you have been convicted of a felony, please explain:

Do you now or have you had within the last six months hepatitis, salmonella, gastrointestinal infections or any other illness which can be spread by serving or preparing food? (required):
YesNo

If hired can you provide documentation to show that you are a U.S. citizen or otherwise authorized to work in the U.S? (required):
YesNo


EDUCATION

High School - Check Last Year Completed (required):
9101112

College - Check Last Year Completed:
1234

Please tell us more about your college education (School, City, State, Major, Degree Type, GPA):


PAST / PRESENT EMPLOYMENT

Please tell us more about your present employment (Name, Address, Employment Dates, Position Held, Supervisor & Title):

Please tell us more about your past employment (Name, Address, Employment Dates, Position Held, Supervisor & Title, Reason for Leaving) (required):

Comments: