Mr. D’s Employment Application Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Are you 18 years of age or older? Yes No Are you eligible to work in the U.S.? Yes No Are you able to provide the acceptable Form I-9 document(s) for employment? Yes No Have you been convicted of or pleaded no contest to a felony within the last 5 years? Yes No If yes, please explain: Position Applying For: Cook Bartender Server Dishwasher Available Start Date: MM DD YYYY Days Available: Please mark available days to work during the week Monday Tuesday Wednesday Thursday Friday Saturday Sunday Hours Available: Please specify available hours to work during a shift Education Name & Address of School | Degree/Diploma | Date of Graduation Skills & Qualifications Licenses, Skills, Training, or Awards Name of Previous Employer Position or Title Supervisor's Name Supervisor's Email Address Employer's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you currently employed here? Yes No How long were you employed? From: __ To:__ Responsibilities Reason for Leaving May we contact your employer? Yes No Name of Previous Employer Position or Title Supervisor's Name Supervisor's Email Address Employer's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you currently employed here? Yes No How long were you employed? From: __ To:__ Responsibilities Reason for Leaving May we contact your employer? Yes No References Name | Title | Address | Phone Number * I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above. I certify this information is correct Thank you for your application submission!
