Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date Available
MM
DD
YYYY
Drivers License Number
*
Do you have reliable transportation? If no, please provide details.
*
Position Applying for
Manager
Bartender
Server
Hostess
Cook
Dishwasher
Busser
Housekeeping/Janitor
Support/Other
Are you a citizen of the United States?
*
Yes
No, but I am authorized to work in the U.S.
No
If no, are you authorized to work in the U.S.?
Yes
No
Contact - Previous Employment 1
*
Company, Address, Supervisor Name & Phone Number
Details - Previous Employment 1
*
Job Title, Starting Salary & Ending Salary, Responsibilities, Reason for Leaving, Start and End Date
May we contact this previous supervisor?
*
Yes
No
Contact - Previous Employment 2
*
Company, Address, Supervisor Name & Phone Number
Details - Previous Employment 2
*
Job Title, Starting Salary & Ending Salary, Responsibilities, Reason for Leaving, Start and End Date
May we contact this previous supervisor?
*
Yes
No
Contact - Previous Employment 3
Company, Address, Supervisor Name & Phone Number
Details - Previous Employment 3
Job Title, Starting Salary & Ending Salary, Responsibilities, Reason for Leaving, Start and End Date
May we contact this previous supervisor?
Yes
No
Reference #1
*
Please include their Full Name, Company, Relationship, Phone Number, Address.
Reference #2
*
Please include their Full Name, Company, Relationship, Phone Number, Address.
Reference #3
*
Please include their Full Name, Company, Relationship, Phone Number, Address.
Branch
Rank at discharge
Type of discharge
If other than honorable, please explain
Date Started
MM
DD
YYYY
Date Ended
MM
DD
YYYY
Digital Signature
First Name
Last Name
By submitting this form, I confirm the following:
*
Check both boxes
The information provided is honest and accurate to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.