Full name

Date

Phone

Email

Address

Position applying for...

Server

Bartender

Host

Busboy

Dishwasher

Cook

Kitchen mgmt

FOH mgmt

Salary Requirement

Referred by

Date available to start

If under 18, can you provide a work permit

Yes

No

Have you ever worked for this company before

Yes

No

Are you a Citizen of the United States

Yes

No

If not, are you legally allowed to work in the USA?

Yes

No

Select one

Full-time

Part-time

Select Days and/or nights

Days

Nights

Both

Have you ever pleaded guilty, no contest or been convicted of a crime?

Yes

No

If yes, please provide dates and details

Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Summarize your special skills or qualifications

Previous employment

Date of employment - From

To

Position held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reasons for leaving

May we contact this employer for a reference?

Yes

No

Date of employment - From

To

Position held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reasons for leaving

May we contact this employer for a reference?

Yes

No

Date of employment - From

To

Position held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reasons for leaving

May we contact this employer for a reference?

Yes

No

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.