Employment Application

Personal Information
Name*
First Last
Email*
Current Address*
Street Address Address Line 2 City State ZIP Code
Permanent Address
Street Address Address Line 2 City State ZIP Code
Phone (mobile)*
Phone (landline)
Are you under 18 years of age?*
- Yes
- No
Birth Date
MM slash DD slash YYYY
Are you eligible to work in the United States?*
- Yes
- No
If hired, do you have reliable transportation to and from work?*
- Yes
- No
Describe your transportation
Emergency Contact Name*
First Last
Emergency Contact Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact Phone*
Are you a military veteran?
- Yes
- No
Military Branch
Date of Enlistment
MM slash DD slash YYYY
Date at Discharge
MM slash DD slash YYYY
Rank at Discharge

High School Education
High School*
High School Location*
City State
Grade Completed*
Please enter a number from 7 to 12.
Grade Point Average
Please enter a number from 0 to 4.
Did you graduate high school?*
- Yes
- No
College Education
College Attended
College Location
City State
Year Completed
Grade Point Average
Please enter a number from 0 to 4.
Did you graduate from college?
- Yes
- No
Trade/Business School
School Name
School Location
City State
Education Completed
Grade Point Average
Please enter a number from 0 to 4.
Did you graduate trade/business school?
- Yes
- No

Employment History
Employer #1 Name
Employer #1 Location
City State
Employer #1 Job Duties
Employer #1 Month/Year Hired
Employer #1 Month/Year Ended
Employer #1 Starting Wage
Employer #1 Ending Wage
Reason for Leaving Employer #1
May we contact employer #1?
- Yes
- No
Employer #2
Employer #2 Name
Employer #2 Location
City State
Employer #2 Job Duties
Employer #2 Month/Year Hired
Employer #2 Month/Year Ended
Employer #2 Starting Wage
Employer #2 Ending Wage
Reason for Leaving Employer #2
May we contact employer #2?
- Yes
- No
Employer #3
Employer #3 Name
Employer #3 Location
City State
Employer #3 Job Duties
Employer #3 Month/Year Hired
Employer #3 Month/Year Ended
Employer #3 Starting Wage
May we contact employer #3?
- Yes
- No
Employer #3 Ending Wage
Reason for Leaving Employer #3

References
Use persons not related to you whom you have known for at least one year.
Reference #1 Name*
First Last
Reference #1 Address*
Street Address City State
Reference #1 Phone*
Reference #1 Years Accquainted*
Reference #1 Relationship*
- Business
- Personal
Reference #2 Name*
First Last
Reference #2 Address*
Street Address City State
Reference #2 Phone*
Reference #2 Years Accquainted*
Reference #2 Relationship*
- Business
- Personal
Reference #3 Name*
First Last
Reference #3 Address*
Street Address City State
Reference #3 Phone*
Reference #3 Years Accquainted*
Reference #3 Relationship*
- Business
- Personal
Terms & Conditions
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 or omission of facts called for is cause for dismissal and that my employment is substantially dependant on truthful answers to the fore going inquiries
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.
Authorization*
- I understand and agree to the above provisions.
Tip Allocation for Servers*
- I understand and agree to this tip allocation policy.
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 “reflects a good faith approximation of the actual distribution of tip income.”

Employment Application

Step 1 of 5

Personal Information

High School Education

College Education

Trade/Business School

Employment History

Employer #2

Employer #3

References

Terms & Conditions