First Name

Last Name

Email Address

Street Address, Apt #

State

Zip

City

Phone

Position Applying for Position Applying for Server Cook Dishwasher Busser Host Bartender Manager

How old are you?

Hours/Days you are available for work

Previous Employment History

Previous Employment History Second

Previous Employment History Third

Education

References: Name, Email or Phone number

References: Name, Email or Phone number Second

References: Name, Email or Phone number Third

Tell Us More About You

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? Yes No

If hired, can you furnish proof that you are eligible to work in the U.S.? If hired, can you furnish proof that you are eligible to work in the U.S.? Yes No

Have you ever been convicted of any law violation? Have you ever been convicted of any law violation? Yes No

Include any plea of “guilty” or “no contest”. Exclude any minor traffic violations. If YES, give details. A conviction will not necessarily disqualify an applicant for employment.

Signature

Date