First Name

Last Name

Email Address

Street Address, Apt #

State

City

Zip Code

Phone

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

Hours/Days you are available for work

1. Previous Employment History

2. Previous Employment History

3. Previous Employment History

Education

1. References: Name, Email or Phone number

2. References: Name, Email or Phone number

3. References: Name, Email or Phone number

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