Employment

First Name:

Position applying for?

—Please choose an option—Wait StaffBusserHostessCashierKitchen PrepPart Time Catering StaffOyster ShuckerShort Order Cook

Last Name:

Date you can start work?

Your Cell Number:

Referred by:

Address:

Salary Desired:

City:

Hours available to work:

State:

—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Total Hours per week:

Zip Code:

Are you currently employed?

—Please choose an option—YesNo

Email:

May we contact your employer?

—Please choose an option—YesNo

Phone Number:

Current/Former Employer 1:

High School:

Position for Employer 1:

Year Graduated:

Salary For Employer 1:

College:

Dates Employed for Employer 1:

Year Graduated:

Former Employer 2:

Technical/Trade School:

Position for Employer 2:

Year Graduated:

Salary for Employer 2:

Special Studies:

Dates Employed for Employer 2:

US Military Service:

Former Employer 3:

Rank:

Position for Employer 3:

Salary for Employer 3:

Dates Employed for Employer 3:

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge, and I understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement for employment contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Full Name

Date