LOT 9

Application for Employment

We are an Equal Opportunity Employer

We are an equal opportunity employer and fully subscribe to the principles of equal opportunity. It is our policy to seek and employ the best qualified personnel in all positions without regard to race, color, religion, age, sex, disability, national origin or any other basis made unlawful by either state or federal law.

Position Applied For

Date

Personal Information

Last Name

First Name

Middle

SSN (Last 4)

Address

City

State

ZIP

Phone Number

Email Address

How long at above address?

Eligibility

Are you 18 years old or older?

Yes No

Have you had any name changes this employer should know about?

Yes No

Do you have transportation to and from work?

Yes No

Are you authorized to work in the U.S.?

Yes No

Date You Can Start

Salary Desired

Type of Employment Sought

Full Time Part Time Temporary

Availability

Days Only Nights Only Days/Nights

Who recommended you for this position?

Please Check the Kind of Work You Have Done

Bartender Bus Person Carver Chef Cook Cook Helper Wait Staff Dishwasher Food Prep Technician Host or Hostess Kitchen Helper Manager Pastry Cook Cold Line Vegetable Cook

Education

Schooling	Name and Address of School	Grade or Degree Completed	Graduate — Yes	Graduate — No
High School
College or University
Others (Specify)
Military Service Schools Attended

Military Service Record

War Veteran?

Yes No

Branch

From (Date)

To (Date)

Highest Grade

Previous Restaurant Experience

List your last four employers, starting with the most recent first.

Employer 1

Company Name

Company Business

Address

Phone

Your Position

Immediate Supervisor

Title

Reason for Leaving

Date Started

Starting Salary

Date Left

Ending Salary

Job Duties

Employer 2

Company Name

Company Business

Address

Phone

Your Position

Immediate Supervisor

Title

Reason for Leaving

Date Started

Starting Salary

Date Left

Ending Salary

Job Duties

Employer 3

Company Name

Company Business

Address

Phone

Your Position

Immediate Supervisor

Title

Reason for Leaving

Date Started

Starting Salary

Date Left

Ending Salary

Job Duties

Employer 4

Company Name

Company Business

Address

Phone

Your Position

Immediate Supervisor

Title

Reason for Leaving

Date Started

Starting Salary

Date Left

Ending Salary

Job Duties

Additional Information

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 required job duties?

Have you ever applied to this company before?

Yes No

Are you now employed?

Yes No

Emergency Contact

Name

Relationship

Address

Phone

Certification

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 (type your full name)