Employment Application Hi-Way Diner Lincoln Nebraska

Employment / Job Application

Hi-Way Diner
Personal Information
Name

First NameLast Name
Middle Name
Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Social Security Number
XXX-XX-XXX
Date Available

MonthDayYear
Date
Desired Pay
Per Hour or Salary
Pay Type
Position Applied For
Employment Desired
Employment Eligibility
Legally Eligible To Work in the United States?
Have You Ever Worked for Hi-Way Diner Before?
Previous Employment Start Date

MonthDayYear
Start Date
Previous Employment End Date

MonthDayYear
End Date
Have You Ever Been Convicted Of A Felony?
Please Explain Conviction:
If answer Yes to above please answer.
Education
High School:
High School City, State
ex: Lincoln, NE
High School Begin Date

MonthDayYear
Date
High School End Date

MonthDayYear
Date
Graduate High School
High School Diploma
College:
College City, State
ex: Lincoln, NE
College Start Date

MonthDayYear
Date
College End Date

MonthDayYear
Date
College Graduate?
College Degree
Other Education
Other Education City, State
ex: Lincoln, NE
Other Education Start Date

MonthDayYear
Date
Other Education End Date

MonthDayYear
Date
Other Education Degree/Certification:
Other Education 2
Other Education 2 City, State
ex: Lincoln, NE
Other Education 2 Start Date

MonthDayYear
Date
Other Education 2 End Date

MonthDayYear
Date
Other Education 2 Degree/Certification:
Previous Employment
Previous Employer 1 Name
Previous Employer 1 Email
example@example.com
Previous Employer 1 Phone Number

Area CodePhone Number
Previous Employer 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employer 1 Starting Pay
Previous Employer 1 Beginning Pay By Hour/Salary
Previous Employer 1 Ending Pay
Previous Employer 1 Ending Pay By Hour/Salary
Previous Employer 1 Job Title
Previous Employer 1 Responsibilities
Previous Employer 1 Start Date

MonthDayYear
Date
Previous Employer 1 End Date

MonthDayYear
Date
Previous Employer 1 Reason For Leaving
Previous Employer 2 Name
Previous Employer 2 Email
example@example.com
Previous Employer 2 Phone Number

Area CodePhone Number
Previous Employer 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employer 2 Starting Pay
Previous Employer 2 Starting Pay Hourly/Salary
Previous Employer 2 Ending Pay
Previous Employer 2 Ending Pay Hourly/Salary
Previous Employer 2 Job Title
Previous Employer 2 Responsibilities
Previous Employer 2 Start Date

MonthDayYear
Date
Previous Employer 2 End Date

MonthDayYear
Date
Previous Employer 2 Reason For Leaving
Previous Employer 3 Name
Previous Employer 3 Email
example@example.com
Previous Employer 3 Phone Number

Area CodePhone Number
Previous Employer 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employer 3 Starting Pay
Previous Employer 3 Starting Pay Hourly/Salary
Previous Employer 3 Ending Pay
Previous Employer 3 Ending Pay Hourly/Salary
Previous Employer 3 Job Title
Previous Employer 3 Responsibilities
Previous Employer 3 Start Date

MonthDayYear
Date
Previous Employer 3 End Date

MonthDayYear
Date
Previous Employer 3 Reason For Leaving
REFERENCES

(Professional Only)
Reference 1 Name

First NameLast Name
Reference 1 Relationship
Reference 1 Company
Reference 1 Title
Reference 1 Email
example@example.com
Reference 1 Phone Number

Area CodePhone Number
Reference 2 Name

First NameLast Name
Reference 2 Relationship
Reference 2 Company
Reference 2 Title
Reference 2 Email
example@example.com
Reference 2 Phone Number

Area CodePhone Number
Reference 3 Name

First NameLast Name
Reference 3 Relationship
Reference 3 Company
Reference 3 Title
Reference 3 Email
example@example.com
Reference 3 Phone Number

Area CodePhone Number
Military Service
Are You A Veteran
Branch:
Rank At Discharge
Military Service Start Date

MonthDayYear
Date
Military Service End Date

MonthDayYear
Date
Discharge Type
If Not Honorable, Please Explain:
Background Check Consent
If Asked, Are You Willing To Consent To A Background Check?
Disclaimer
Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.
Signature
Date Of Application

MonthDayYear
Date
Name Of Signer

First NameLast Name
Should be Empty:

Employment / Job Application

Personal Information

Employment Eligibility

Education

Previous Employment

REFERENCES

Military Service

Background Check Consent

Disclaimer