Employment Form Position Applied for ---ServerBartenderHostServer Assistant / Food RunnerPrep CookLine CookDishwasherManagement Date First Name* Last Name* Phone Email* Address* City* State* Zipcode* Please check all that apply* At least 18 years of ageIf under 18, able to provide a work permitLegally eligible for employment in the U.S. (proof of U.S. citizenship status is required if hired) Are there any felony charges currently pending against you? If so please explain* Salary Desired Are you seeking full time, part time or temporary employment?* What hours and shifts(s) would you prefer to work?* List times you are not available to work* Are you willing to work:* OvertimeWeekendsHolidaysNone Are you currently employed? If so may we contact your employer?* If hired, when would you be able to start?* List any friends or relatives employed by this company* Have you ever been discharged or asked to resign from any position? If yes, please describe* List any special skill or training for position applied for Education - Select the higest level achieved ---9101112GEDCollege 1-2 YearsCollege 3-4 YearsCollege 5+ Years Name and Location for Secondary/High school Name and Location for College Please attached Resume if available (5MB max file size) Work History 1 - Please start with your most recent and include: Company name, Company phone number, Dates of employment, Beginning and ending salary, Job Title, Supervisor's Name and Telephone number, Describe jod duties and reason for leaving Work History 2 - Please start with your most recent and include: Company name, Company phone number, Dates of employment, Beginning and ending salary, Job Title, Supervisor's Name and Telephone number, Describe jod duties and reason for leaving Work History 3 - Please start with your most recent and include: Company name, Company phone number, Dates of employment, Beginning and ending salary, Job Title, Supervisor's Name and Telephone number, Describe jod duties and reason for leaving For reference purpose have you work for any of the above organizations or attended school under a different name? May we contact the employers listed above, if not list the employers you do NOT wish us to contact and why Authorization & At-Will Employment Agreement I certify that I have personally completed this application. I declare that the information provided in this employment application is true and complete and I understand that any false information or significant omissions may disqualify me from further consideration for employment and may be justification for discipline or dismissal from employment if discovered at a later date. I agree to immediately notify this company if I should be convicted of a crime while my job application is pending or during my employment, if hired. I authorize this company to make an investigation of all information contained in this employment application including disciplinary records of any former employers, police departments and other references or sources concerning me. I release from liability all companies and corporations supplying such information. I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. AT-WILL EMPLOYMENT AGREEMENT I understand and agree that nothing contained in this application, or conveyed during any interview is intended to create an employment contract between the company and me. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment and compensation will be at-will, for no definite period of time, and may be terminated at any time, for any reason, or for no reason at all. I understand that only Daniel Marsh is authorized to change the employment-at-will status and no such change will be enforceable unless it is in writing, pertains specifically to me and is signed by Daniel Marsh. I have read, understand, and agree to the above. Electronic Signature* (Please type your full name as your signature for this application)
