Applicant Information
Full Name
*
First
M.I.
Last
Address
*
Street Address
Apartment/Unit #
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date
*
-
Month
-
Day
Year
Date
Position Applying for
*
Server
Line Cook
Hostess
Bartender
Dishwasher
Bus Boy
Date Available
*
-
Month
-
Day
Year
Date
Desired Salary $
Are you a citizen of the United States?
*
YES
NO
If no, are you authorized to work in the U.S?
*
YES
NO
If yes, when?
Have you ever worked for this company?
*
YES
NO
Have you ever been convicted of a felony?
*
YES
NO
If yes, explain
Previous Employment
Company
Address
Phone Number
-
Area Code
Phone Number
Supervisor
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference
YES
NO
Company
Address
Phone Number
-
Area Code
Phone Number
Supervisor
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference
YES
NO
Signature
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Print Form
Should be Empty: