Employment Application

Personal Information

Name

Address

City

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Phone number

Email Address

Employment Desired

Desired Position
Server Cook Dishwasher Bartender

Desired Start Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Desired Salary

Are You Currently Employed?
Yes No

May We Contact Current Employer?
Yes No

Education History

High School

Did You Graduate?
Select One Yes No

College

Did You Graduate?
Select One Yes No

Trade, Business Or Correspondence School

Did You Graduate?
Select One Yes No

Former Employers

Employer 1 name

Salary

Position

Phone

From Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

To Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

May We Contact This Employer?
Select One Yes No

Employer 2 name

Salary

Position

Phone

From Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

To Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

May We Contact This Employer?
Select One Yes No

Employer 3 name

Salary

Position

Phone

From Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

To Date
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

May We Contact This Employer?
Select One Yes No

About You

Have you ever been convicted of a crime?
Select One Yes No

Additional Comments

Authorization

By submitting below, I certify that the answers 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 the 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 certify that by signing this application, I understand that if I am hired with this company, I will not be paid for training until I am an employee for a minimum of 30 days.