First Name*:

Middle Name:

Last Name*:

Address*:

City*:

State*:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code*:

Phone Number*:

Email Address*:

Position(s) applying for*:
Foodrunner/Host
Server
Bartender
Dishwasher/Prep
Line Cook
Other:

How did you find out about this job?*:
Craigslist Employee Walk-in Relative Other If "Other," describe:

Are you currently employed?*: Yes No

Why are you seeking a job at this time?*:

If hired, do you have a reliable means of transportation to get to work?*:
Yes No Please describe*:

Are you at least 18 years old?*: Yes No
If you are under 18 years of age, can you furnish a work permit?*: Yes No I am 18+

Do you have any medical conditions that would prevent you from performing your duties?*: Yes No

Are you legally eligible for employment in the U.S.?*: Yes No
(Proof of U.S. citizenship or immigration status is required within 3 days of start date if hired.)

Have you been convicted of a crime?*: Yes No
If yes, state the nature of the offense and outcome of the case. Include dates and places.
NOTE: The existence of a criminal record does not constitute an automatic bar to employment.

Employment Information

Have you ever worked here before?*: Yes No
If yes when, and reason for leaving?:

What type of employment are you seeking?*:

Please complete below by noting time frames you are available to work (i.e. 8-5) or "No" if you are unavailable to work.*:

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
AM Shift
PM Shift

If hired, would this be your primary employment?*: Yes No

Hourly rate or salary you are seeking?*:

How many total hours and/or shifts per week do you want to work?*:

Are you willing to work:

Provide a date when would you be able to start if hired?*:

List friends/relatives employed by this company:

Have you ever been discharged or asked to resign from any position/past employment?*: Yes No
If yes, please describe:

List any special skills or training that would make you an asset to our team. Include past experience working with food, knowledge of beer, etc.*:

Please describe tasks, if any, you will need accommodation to perform, and explain what type of accommodation you need.:

Education

High School (highest grade completed)*: 9 10 11 12 GED

Name of High School*:

City, State*:

College (# of years completed): 1 2 3 4 5 6 7 8

Name of College:

City, State:

Degree & Major:

Minor:

Are you actively enrolled in an educational program right now?*: Yes No
If Yes, please describe:

Work History

Most Recent Employment:

Company Name:

Phone Number:

Address:

City:

State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employed from: to

Starting Salary / Rate:
Ending Salary / Rate:

Job Title

Supervisor Name & Title:

Job Description / Duties:

Specific Reason for Leaving:

Additional Employment 2:

Company Name:

Phone Number:

Address:

City:

State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employed from: to

Starting Salary / Rate:
Ending Salary / Rate:

Job Title

Supervisor Name & Title:

Job Description / Duties:

Specific Reason for Leaving:

Additional Employment 3:

Company Name:

Phone Number:

Address:

City:

State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employed from: to

Starting Salary / Rate:
Ending Salary / Rate:

Job Title

Supervisor Name & Title:

Job Description / Duties:

Specific Reason for Leaving:

Additional Employment 4:

Company Name:

Phone Number:

Address:

City:

State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employed from: to

Starting Salary / Rate:
Ending Salary / Rate:

Job Title

Supervisor Name & Title:

Job Description / Duties:

Specific Reason for Leaving:

For references purposes: Have you worked for any of these organizations or attended school under a different name? If yes, give name and organization(s):

May we contact the employers listed above?* Yes No I have no prior employment
If No, list the employers you do not wish us to contact and why?

References

Please list 3 references. If you have had past jobs, at least two references must be work related; supervisors, managers, etc who can answer questions about your work performance.

Reference 1:
Name*:

Company*:

Title / Position*:

Address*:

Phone Number / Other Contact Info*:

How do you know this person?*:

Length of time known?*:

Reference 2:
Name*:

Company*:

Title / Position*:

Address*:

Phone Number / Other Contact Info*:

How do you know this person?*:

Length of time known?*:

Reference 3:
Name*:

Company*:

Title / Position*:

Address*:

Phone Number / Other Contact Info*:

How do you know this person?*:

Length of time known?*:

Authorizations & At-Will Employment Agreement

(Please read carefully, provide your consent by activating the check boxes at the beginning of each section, then digitally sign below.)

* 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 form my 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 and 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.

* I specifically authorize and direct my current and former employers to supply employment-related information to this company and do hereby release my current and former employers from liability for providing information to this company.
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.

* I authorize this company, if applicable, to request a copy of my credit report, motor vehicle driving record, and any other investigative report deemed necessary through various third party sources. As required by law, upon request within a reasonable period of time, I will be notified as to the nature and scope of such investigations.

* I hereby agree to submit to any drug test required of me, whether prior to my employment or if employed by this company at any time thereafter. If requested, I will take a post-job offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician.

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 the company's President is authorized to change the employment-at-will status and such a change can only be done in writing. I have read, understand, and agree to the above.

Signature (Type your full name)*:
Date *: