Madisons Cafe Employment Application

Employment Application

Please complete the form below to apply for a position with us.
Today's Date

Month Day Year
Date
Full Name *

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Phone Number *

Area Code Phone Number
Date Available

Month Day Year
Birth Date *

Month Day Year
Social Security Number *
Desired Salary
Positions Applied for
Are you a citizen of the United States? *

Yes No
If no, are you are eligible to work in the U.S.?

Yes No
Have you ever worked for this company?

Yes No
If yes, when?
Have you ever been convicted of a felony?

Yes No
If yes, please explain

Previous Employment
Company #1
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

Yes No
Company #2
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

Yes No
Company #3
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Job Title
Supervisor
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

Yes No
Military Service
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Should be Empty:

Employment Application