Pre-Employment Questionnaire Equal Opportunity Employer

Select the jobs you would like to apply for: NoneALL POSTIONS

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

Name *
Last Name *
Email Address *
Address *
City *
State *
Zip Code *

Phone Number

Telephone *
Cell phone *

General Information

Date You Can Start *
Position Applying For *	Bartender Server Delivery Driver Busser Togo orders bagger Host/Hostess Cook Dishwasher Other
Salary Desired *
Are You Employed Now? *	Yes No
If so, May We Inquire of Your Present Employer?	Yes No
If we can contact your current employer, please give contact information – Name of Business, Name of contact and phone number.

Education History

High School *
High School Graduation Year
College *
College Graduation Year
Trade, Business, or Correspondence School
Subject of Special Study/Research Work

Qualifications

Special Training
Special Skills
U.S. Military or Naval Service

Former Employers (List below last four employers, starting with the last one first)

Name and Address of Employer
From
To
Salary
Position
Reason for Leaving
Name and Address of Employer
From
To
Salary
Position
Reason for Leaving
Name and Address of Employer
From
To
Position
Salary
Reason for Leaving
Name and Address of Employer
From
To
Position
Salary
Reason for Leaving

Authorization “I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herin and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.” In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.