Application for Employment

Personal Information

Date: Name Last: First: Middle: Social Security Number: Present Address, Street: City: State: Zip: Permanent Address, Street: City: State: Zip: Phone Number: Are you under 18 years of age? Yes No If yes, list birth date Have you ever been employed by this company before? Yes No Where? When Manager's Name Are you eligible to work in the United States? Yes No If hired do you have a reliable means of transportation to get to work? Yes No Explain: What interests, hobbies, or extra curricular activities do you have (exclude those that are religious or ethnic in nature): Have you ever been convicted of a felony or misdemeanor other than a traffic violation? Yes No If yes, explain:

Employment Desired

Position applying for: Full or Part Time Date available: Rate of pay desired: Please indicate below the days and hours on those days that you would be available to work: Monday Yes No Hours: Tuesday Yes No Hours: Wednesday Yes No Hours: Thursday Yes No Hours: Friday Yes No Hours: Saturday Yes No Hours: Sunday Yes No Hours:

Employment History

(List below former employers, starting with last one first)

Date, Month, Year Employer's Name, Address Supervisors Name/Phone Job Title and Duties Salary/Wage Reason for Leaving From:  To:      From:  To:      From:  To:      From:  To:      May we contact the past and/or present employers listed above? Yes No If no, then indicate those you do not want us to contact.

IN CASE OF EMERGENCY, NOTIFY: Name: Address: Phone Number:

Education

Schooling Name and Location of School Grade Year GPA Graduate High School Yes No College Yes No Trade/Business Yes No Other (specify) Yes No

References

Give the names of persons not related to you as references, whom you have known at least 1 year   Name Address Phone Number Years Acquainted Personal/Business 1. 2. 3. Are you known to schools/references by another name? Yes No If yes, please indicate the name(s):

1.	I authorize investigation of all statements contained on this application except where I have requested on this form that no investigation be made.
2.	I understand that misrepresentation of omission of facts called for is cause for dismissal and that my employment is substantially dependent on truthful answers to the foregoing inquires.
3.	I understand that nothing contained in this employment application or in the granting of an interview is intended to nor does it create an employment contract between the company and myself for either employment or the providing of any benefit. In the event that an employment relationship is established, I understand that I have the right to terminate my employment at any time for any reason or no reason, and the Company retains the same right regarding the discontinuation of my employment.
	By checking this box, I acknowledge all information to be accurate and agree to the above terms.

Server Applicants Only

If tip allocation is required, I agree that allocating tips based upon hours worked per tipped employee reflects a good faith approximation of the actual distribution of income among the tipped employees in this establishment. NOTE: IRS rules require that the allocation method "reflect a good faith approximation of the actual distribution of tip income".   By checking this box, I agree to the above terms

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