Date: January February March April May June July August September October November December     Date: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     Year: 2007 2008 2009 2010 2011 2012 2013 2014 2015
Last Name: First Name: Middle Init:
Social Security Number:
Present Street Address:
City:State:ZIP Code:
Telephone Number:How long have you lived at this address?
Are you 18 years of age or older?   YES NO

If you are not 18, what is your date of birth?

Previous Street Address:
City:State:ZIP Code:

Your e-mail address:

Position(s) Applying For:
Cashier/Host/Hostess Cook Cook Helper/Prep Cook Busser Dishwasher Waiter/Waitress
Hourly Salary Desired:    Date You Can Start

Please indicate your preference (check all that apply):
Full Time Part Time Temporary Days ONLY Nights ONLY No Shift Preference

I can work from (date):    thru (date):
Further Explanation, if necessary:

Have you ever been bonded?    YES NO
On What Jobs:

Do you have a valid drivers license?    YES NO
Do you have access to a vehicle?    YES NO

Are you a U.S. Citizen?    YES NO

Have you ever been convicted of a felony?    YES NO

How did you hear about this position or Family Chef?

If you are related to anyone in this establishment, please give their name:

Please tell us how much education you have completed, what year you graduated, from what grade, and the school name.  If you are still in school, please tell us where and what grade you are in:

Please Check all types of work that you have done:
Bartender Bookkeeper Bus Person Chef Cook Cook Helper Counter Cashier Dietitian Dishwasher Prep Cook Fountain Host or Hostess Janitor Kitchen Helper Manager Salad Bar Sandwiches Vegetable Cook Waiter/Waitress

Please list your last three employers, starting with the most recent:
Company:
Company Address:
City, State, Zip:
Telephone:    Supervisor Name:
Your Position:    Hourly Salary:
Date you started:    Date Left:
Reason For Leaving:

2. Company:
Company Address:
City, State, Zip:
Telephone:    Supervisor Name:
Your Position:    Hourly Salary:
Date you started:    Date Left:
Reason For Leaving:

3. Company:
Company Address:
City, State, Zip:
Telephone:    Supervisor Name:
Your Position:    Hourly Salary:
Date you started:    Date Left:
Reason For Leaving:

Please list any physical limitations or problems which may affect your work:

Is there anything we could do to accommodate your limitations?

Have you ever applied to this company before?    YES NO
If so, when did you apply before?

Are you employed now?    YES NO
If you are now employed, please give the phone number:

In case of an emergency, who should we notify?
Name:
Address:
City, State, Zip:
Telephone:    Relationship, if any:

Comments or additional experience that you think may be helpful:

1. I Authorize Investigation of All Statements Contained in This Application.

2. I Understand That Misrepresentation or Omission of Facts Called For is Cause For Dismissal and That My Employment is Substantially Dependent on Truthful Answers to the Foregoing Inquiries.

3.  I Understand That if Any Bonus is Offered, A Condition of Payment is Dependant Upon My Being Available for Work as Stated on This Application, and is also Dependent on Performing My Job in a Satisfactory Manner.

4. I Have Read These Statements and Answers To These Inquiries:

YES NO      Type in your full name: