Job Application

Desired Starting Pay (per hour)*

Name*

First NameLast Name

Date*

Date

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email*

example@example.com

Phone*

Date of Birth*

Date

Date Available*

Date

Are you authorized to be employed in the United States?*

YesNoNot sure

Have you been convicted of a felony or have ANY convictions from the last 5 years?*

YesNoNot sure

If yes, explain if desired

Are you at least 18 years of age? Being less than 18 does not prevent your employment, but it does restrict you from serving alcohol.*

YESNONo, but will be soon

High School Name City & State Dates Attended

College/Trade School Name City & State Dates Attended

Company

Phone

Address

Supervisor

Job Title

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

Company

Phone

Address

Supervisor

Job Title

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference?

YesNo

Please specify what days/shifts you are available. Please be specific. *

	9am - 3pm	9am - 5pm	3pm -11pm	5pm-11pm	Available All Day	NOT Available All Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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.

Tell us why you think you would like to work with us.*

Any other information you want to share

Signature*

APPLICANT INFORMATION

EDUCATION

PREVIOUS EMPLOYMENT

DISCLAIMER AND SIGNATURE