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Full Name (First, Middle, Last required)

Telephone Number (preferred)

Address (Include City, State, Zip Code)

Email Address

Please indicate any other names you have used while working or attending school.

Are you under the age of 18? Are you under the age of 18? Yes No

If required, can you provide a valid work permit? If required, can you provide a valid work permit? Yes No

Position Desired Position Desired Host/Wait Kitchen

Pay Expected

Are you available to work on weekends? Are you available to work on weekends? Yes No

Anticipated date you are available for employment

How did you hear about us?

When are you available to work? When are you available to work? Monday-Friday 7AM-3PM Monday-Friday 4PM-9PM Saturday 7AM-3PM Saturday 4PM-9PM Sunday 7AM-3PM

Total Hours Available Per Week

Shifts Preferred Shifts Preferred Days Nights Weekends

Are you willing to pick up extra shifts if needed? Are you willing to pick up extra shifts if needed? Yes No

What is the highest educational degree you've earned? What is the highest educational degree you've earned? High School Diploma Associate's Degree Bachelor's Degree Master's Degree None of the above

Are you currently enrolled in school? Are you currently enrolled in school? Yes, I'm a high school student Yes, I'm a college student No, I am not a student

Do you participate in any extracurricular activities? If yes, please list:

Name and Location of High School

# of Years Completed (High School)

Name and Location of College/University

# of Years Completed (College)

Course of Study

Type of Degree/Certificate

Previous Employer #1 (Complete Name and Address)

Employer #1 Phone Number

Your Job Title

Starting Wage

Ending Wage

Date Ended

Date Started

Supervisor's Name

May we contact this employer? May we contact this employer? Yes No

Description of Duties

Reason for Leaving

Previous Employer #2 (Complete Name and Address)

Employer #2 Phone Number

Your Job Title

Date Started

Date Ended

Starting Wage

Ending Wage

Supervisor's Name

May we contact this employer? May we contact this employer? Yes No

Description of Duties

Reason for Leaving

Have you ever been convicted of a misdemeanor/felony? Have you ever been convicted of a misdemeanor/felony? Yes No

If you have been convicted of a misdemeanor/felony, please explain:

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