| Contact Information |
| First Name: |
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| Last Name: |
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| Address Street: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Phone: |
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| Email: |
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| Are you 18 years or older? |
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| If not 18+, how many hours/week are you employed elsewhere? |
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| If not 18+, state date of birth: |
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| Do you have transporation to/from work? |
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| Are you authorized to work in the U.S.? |
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| Job Interest |
| Which restaurant(s) are you interested in working? |
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| What type of position(s) are you applying for? |
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| What employment term are you applying for: |
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| When can you start? |
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| Desired pay per hour: |
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| How did you hear about this restaurant: |
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| Education |
| High School (Name): |
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| High School (City & State): |
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| High School (Approximate GPA): |
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| Graduation Status: |
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| College, Technical College, Military or Other (Name): |
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| College, Technical College, Military, or Other (City & State): |
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| College, Technical College, Military, or Other (Area of Study): |
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| Graduation Status: |
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| Employment History |
| Company 1 - Name: |
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| Company 1 - City & State: |
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| Company 1 - Dates of Employment: |
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| Company 1 - Position(s): |
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| Company 1 - Wage per Hour: |
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| Company 2 - Name: |
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| Company 2 - City & State: |
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| Company 2 - Dates of Employment: |
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| Company 2 - Position(s): |
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| Company 2 - Wage per Hour: |
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| Company 3 - Name: |
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| Company 3 - City & State: |
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| Company 3 - Dates of Employment: |
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| Company 3 - Position(s): |
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| Company 3 - Wage per Hour: |
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| Company 4 - Name: |
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| Company 4 - City & State: |
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| Company 4 - Dates of Employment: |
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| Company 4 - Position(s): |
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| Company 4 - Wage per Hour: |
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| Please list any job duties that you would be unable to perform: |
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| Is there anything that we could do to accomodate you so you could perform all the required job duties: |
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| Comments: |
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I authorize investigation of all statements listed above |
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I understand misprepresentation of facts is cause for dismissal |
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I understand my employment is sub-dependent on the answers above |
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I have read these statements and answers to these inquiries |
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