VERMONT PUB & BREWERY EMPLOYMENT APPLICATION

TODAYS DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
VERMONT PUB & BREWERY EMPLOYMENT APPLICATION
NAME
PRONOUNS
PHONE
Format: (000) 000-0000.
POSITION APPLIED FOR
EMAIL
example@example.com
PREFERRED CONTACT METHOD
US CITIZEN?
W4 DEPENDENTS?
BIRTHPLACE
BIRTH DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
CURRENT ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at your current address?
ADDRESS FOR W2 IF DIFFERENT

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PERSON TO NOTIFY IN CASE OF EMERGENCY
EMERGENCY CONTACT PHONE
Format: (000) 000-0000.
How DID YOU HEAR ABOUT VPB
WHAT MADE YOU WANT TO APPLY
EMPLOYMENT HISTORY
BEGIN WITH MOST RECENT EMPLOYMENT, THEN INCLUDE ALL FOOD SERVICE EXPERIENCE.
PREVIOUS EMPLOYER #1
LOCATION OF COMPANY
SUPERVISOR
SUPERVISOR CONTACT PHONE
Format: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
HOURLY WAGE
JOB TITLE/DUTIES
REASON FOR LEAVING
PLEASE INCLUDE ANY OTHER FOOD SERVICE JOBS YOU HAVE HELD:
PREVIOUS EMPLOYER #2
LOCATION OF COMPANY
SUPERVISOR
SUPERVISOR CONTACT PHONE
Format: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
HOURLY WAGE
JOB TITLE/DUTIES
REASON FOR LEAVING
PREVIOUS EMPLOYER #3
LOCATION OF COMPANY
SUPERVISOR
SUPERVISOR CONTACT PHONE
Format: (000) 000-0000.
START DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
END DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
HOURLY WAGE
JOB TITLE/DUTIES
REASON FOR LEAVING
NOW TELL US ABOUT YOUR SCHEDULING AVAILABILITY
How MANY HOURS PER WEEK DO YOU WANT TO WORK

NOW, PLEASE TELL US ABOUT YOUR AVAILABILITY:

Rows	CURRENT SCHEDULING CONFLICTS DAY SHIFTS (10-5)	CURRENT SCHEDULING CONFLICTS NIGHT SHIFTS (4-11)	PREFERRED DAY SHIFTS (10-5)	PREFERRED NIGHT SHIFTS (4-11)
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

ALL STAFF ARE REQUIRED TO WORK WEEKENDS AND HOLIDAYS WHAT IS YOUR SCHEDULING AVAILABILITY?
PLEASE LIST ANY DATES THAT YOU WOULD NEED TO HAVE OFF
DO YOU HAVE ANY OTHER ITEMS TO NOTE ABOUT SCHEDULING? (PLEASE LIST REASONS FOR CURRENT SCHEDULING CONFLICTS (SCHOOL, CHILD-CARE, OTHER JOB, TRANSPORTATION, ETC)
WHAT DO YOU ENJOY ABOUT WORKING IN THE SERVICE INDUSTRY
IS THERE ANYTHING ELSE YOU WOULD LIKE TO ADD?
I hereby authorize the Vermont Pub & Brewery to investigate the above statements and references, and indemnify them from any liability arising there from. I understand that any misrepresentation of facts in this application will be cause for discharge if I am employed hereafter. I understand that employment with this business is at will, terminable at the will of the employer, and no contract of employment is either expressed or implied by this document or guaranteed to any employee by the employer. The Vermont Pub & Brewery is an equal opportunity employer.
APPLICANT SIGNATURE
DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

VERMONT PUB & BREWERY EMPLOYMENT APPLICATION

EMPLOYMENT HISTORY

NOW TELL US ABOUT YOUR SCHEDULING AVAILABILITY