Employment Application

Date*
MM slash DD slash YYYY
Name*
First Last
Current Address*
Street Address Address Line 2 City State ZIP Code
Street Address (if you have lived at current address less than 2 years)*
Street Address Address Line 2 City State ZIP Code
Phone*
Email
What position are you applying for?*
Employment History*
Dates Worked Company Name Pay Rate (hourly/weekly) Telephone Number Supervisor's Name Job Title Reason for Leaving
Reference*
Name Phone Number Relationship
Reference*
Name Phone Number Relationship
Reference*
Name Phone Number Relationship
Are you legally eligible to work in the United States?*
Have you ever been convicted of a felony or violation other than a minor traffic infraction?*
Do you have a driver's license?*
Do you have reliable transportation?*
Have you ever applied with us before?*
Do you have your Food Handlers certification?*
Are you able to work every Friday from 8:00 am to 3:00 pm and most Friday & Saturday nights?*
Are you a smoker?*

Dates Worked	Company Name	Pay Rate (hourly/weekly)	Telephone Number	Supervisor's Name	Job Title	Reason for Leaving

Name	Phone Number	Relationship

Name	Phone Number	Relationship

Name	Phone Number	Relationship