Application for Employment Date: Name: Address: Phone Number: Email Address: Birth Date: Emergency Name and Contact Number: Position Applying For: Position Applying For:Waitress/WaiterDishwasherBusserCook Desired Pay/hr: Desired Hrs/Per Week Currently Employed?: Currently Employed?:YesNo If So, Name of Business and Type of Work: Yrs of Expr. in Desired Position: May We Contact your Current Employer: May We Contact your Current Employer:YesNo If, So, Contact Name & Phone Number: Availability (Dates & Times): Former Employment Dates of Employment: Name of Employer: Salary: Position, Duties: Reason For Leaving: Dates of Employment: Name of Employer: Salary: Position, Duties: Reason For Leaving: Education High School Diploma?: High School Diploma?:YesNoGED Date Received: College Degree?: College Degree?:YesNo Date of Degree: Hepatitis "A" Vaccine Date #1: Hepatitis "A" Vaccine Date #2: Are You On Probation Or Parole?: Are You On Probation Or Parole?:YesNo References (One Personal, One Professional): Name of Personal Reference: Personal Reference Phone Number: Relationship: Years Acquainted: Name of Professional Reference: Professional Reference Phone Number: Relationship: Years Acquainted: Message: Application Disclaimer By submitting this application electronically I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating and applicant for consideration for employment on any basis prohibited by applicable local, state, or federal law. If I am hired, I understand that I am free to resign at any time, with or without cause and with or notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specific period of definite duration. Submit Application for Employment Date: Name: Address: Phone #: Email: Birth Date: Emergency Name and Contact #: Position Applying For: Position Applying For:Waitress/WaiterDishwasherBusserCook Desired Pay/hr: Desired Hrs/Per Week Currently Employed?: Currently Employed?:YesNo If So, Name of Business: Type of Work: Yrs of Expr. in Desired Position: May We Contact your Current Employer: your Current Employer:YesNo If, So, Contact Name & Phone #: Availability (Dates & Times): Former Employment Dates of Employment: Name of Employer: Salary: Position, Duties: Reason For Leaving: Dates of Employment: Name of Employer: Salary: Position, Duties: Reason For Leaving: Education High School Diploma?: High School Diploma?:YesNoGED Date Received: College Degree?: College Degree?:YesNo Date of Degree: Hepatitis "A" Vaccine Date #1: Hepatitis "A" Vaccine Date #2: Are You On Probation Or Parole?: Are You On Probation Or Parole?:YesNo References (One Personal, One Professional): Name of Personal Reference: Personal Reference Phone Number: Years Acquainted: Relationship: Name of Professional Reference: Professional Reference Phone Number: Years Acquainted: Relationship: Message: Application Disclaimer By submitting this application electronically I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating an applicant for consideration for employment on any basis prohibited by applicable local, state, or federal law. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specific period of definite duration. Submit