Name
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First Name
Last Name
Day Time Phone
*
(###)
###
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Night Time Phone
(###)
###
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Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Applying for:
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Bartender
Server
Cook
Kitchen Manager
Assistant Manager
Security
Any Position
Position Type
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Can you work Overtime
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Do you have the ability to perform the essential function of the job for which you have applied?
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If hired can you provide documentation to show that you are a U.S. citizen or otherwise authorized to work in the U.S?
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Do you now or have you had within the last six months hepatitis, salmonella, gastrointestinal infections or any other illness which can be spread by serving or preparing food?
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Have you ever been convicted of a felony in the last seven years?
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If Yes, explain
Company Name
Phone
(###)
###
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First Employers Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Position/Duties
Start and End Date (Reason For Leaving)
Pay Rate
Company Name
Phone
(###)
###
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Position/Duties
Start and End Date (Reason For Leaving)
Pay Rate
Company Name
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Position/Duties
Start and End Date (Reason For Leaving)
Pay Rate
High School: School Name, City/State, Degrees and Certifications
College or Business School : School Name, City/State, Degrees and Certifications
Vocational or Other School: School Name, City/State, Degrees and Certifications
Positions of leadership, activity, honors, and accomplishments in school, Military, business or any other information which relates to your ability to perform the position for which you are applying.
First Reference
First Name
Last Name
Phone
(###)
###
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Relationship
Second Reference
First Name
Last Name
Phone
(###)
###
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Relationship
Third Reference
First Name
Last Name
Phone
(###)
###
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Relationship
DO NOT CHECK UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
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