First Name*
Last Name*
Phone*
Email
Are you authorized to work in the US? * Have you worked for this company? * Have you been convicted of a felony? * Previous Company *
Employment Date *
Rate of Pay
Supervisor
Job Title and Responsibilities: *
Do you have open availability? * Yes No
Lunch (10:30-3pm) Afternoon (1pm-6pm) Dinner (4pm-8pm)
Are you able to work all holidays? * Yes No
Holidays that your not able to work.
I certify that the answer given herein are true and complete to the best of my knowledge. I authorize the investigation of all
matters contained in this application and hereby give the Employer permission to contact school's, previous employers,
references, and others, and hereby release the employer from any liability as a result of such contact. I understand that
misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further
consideration for employment. ln addition, if employed, any misrepresentations or omissions of facts called for in this application
wit be cause for dismissal t at any time without any previous notice.
This Employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without
regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation,
gender identity or expression, or any other characteristic protected by federal, state or local laws. We assure you that your
opportunity for employment with this Employer depends solely upon your qualifications.
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