Please print the form below, fill in the appropriate information, and return the form to the location being applied to.

Position Applying For:
___Chef
___Saute' Cook
___Salad/Prep
___Pizza Maker
___Server
___Bus Person
___Dish Washer
___Delivery Person
___Cashier/Hostess/Counter


Date: ___/___/___ 		What is your Availability?
__________________________
__________________________
__________________________
__________________________
__________________________



Name:___________________________    Social Security Number: ________________________
Address: ______________________________________________________________________
Home Phone Number: ___________________    Beeper/Cell Phone Number:_________________
Availability:    Lunch:    ___________________    Dinner: _____________
Are you currently employed? _____ If so, may we inquire of your present employer? __________
Available to work Holidays?  _____ Amount of hours per week you wish to work:    __________
Ever applied to this company before? _____ If so, when ? _____________________



  Name & location of school Year Did you graduate? Subject Studied
 Grammar school  
 		  
 		  
 		  
 
 High School  
 		  
 		  
 		  
 
 College  
 		  
 		  
 		  
 
 Trade /
   Business School		  
 		  
 		  
 		  
 


Subjects of special study or training skills: ___________________________________________
___________________________________________________________________________
___________________________________________________________________________
     *Please note: The position you are applying for may require lifting up to fifty pounds!*




FORMER EMPLOYERS
List the last four employers starting with the most recent.

Date/Month/Year Name & Address Supervisor/Phone No. Wage/Position Reason for Leaving
   Start: _______
   End:  _______		        
   Start: _______
   End:  _______		        
   Start: _______
   End:  _______		        
   Start: _______
   End:  _______		        

REFERENCES (3)

Name Address Business Years Known

1.		      

2.		      

3.		      

Skills, Organizations, Memberships, Hobbies: ____________________________________________


AUTHORIZATION: I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing unless it is in writing and signed by an authorized company representatives.

Signature: __________________________________________   Date: ______________


DON NOT WRITE BELOW THIS LINE


Neatness: _______________________________ Character: _______________________________
Ability: _______________________________ Personality: _______________________________
Hired:      ___________ Position: ____________ Wages:       ___________ Date to report:________