iAtw + ToAsT
Breakfast - Lunch
APPLIGATION FOR EMPLOYMENT
lVe ore an equal opportunity employer.
Dote: / /
Name:
First Middle
Address:
Street Address City State Zip Code
Telephone Number (___J
Do you have a legal right to work in the United States? yes No
Position Applying for:
Date you can start: JJ_
some jobs require that you are able to lift 50 pounds; can you lift 50 pounds?
Yes No If not, please explain:
Days Available to work: M w-Th-.-*F---sat_Sun--
Do you have any objections to working?
Holiday? Yes No
Overtime? Yes No
Do you have dependable transportation to work? Yes No
Have you ever been disciplined or fired from a job? Yes No
If yes, please explain:
What grade have you completed at school?
,*i ,J
CURRENT AND FORMER EMPTOYEES I
(List most recent emPloYer first.)
1.
Name of CompanY
Position
Address of CompanY City, State ZiP Code
t l- to
Phone NumberofComPanY -r-l- -l-/-
Dates of Employment
If no longer employed here, what is your reason for leaving?
Wage: $ Maywe checkwith this employer? Yes No
Immediate SuPervisor
2.
Position
Name of ComPanY
Address ofComPanY City, State ZiP Code
_l_/_ Dates to _l_/_
of EmPloYment
Phone Number ofComPanY
If no longer employed here, what is your reason for leaving?
Wage: $ May we checkwith this employer? Yes No
lmmediate SuPervisor
3.
Position
Name of ComPanY
Address ofComPanY ciry,state zipcode
I /- to
ffi , -/-/-
-'-'ilrt*rofrffimeni
If no longer employed here, what is your reason for leaving?
Wage: $--- Maywe checkwith this employer? Yes No
Immediate SuPervisor
PERSONAI REFERENCES
Give the names of n,lro people, not related to you, whom you
have known for at least
one year, and whom we may call for a personal reference.
1.
Name (First, Last) Phone Number Years Acquainted
What is your relationship to this reference?
2.
Name (First, Last) Phone Number Years Acquainted
What is your relationship to this reference?
UNDERSTANDING
I authorize investigation of all statements contained in this application form, if I am
considered for employment. I also understand that misrepresentation or omission
of the facts called for Lerein or receipt of unsatisfactory references will be sufficient
cause for dismissal from the company's service. If any of tf,e facts called for herein
change during the course of employmen! this may be sufficient cause for
reassignment or dismissal from the company's service. I further understand that
this policy cannot be changed except in writlng.
I understand that my employment can be terminated at any time, with
or without
cause, and with or without notice, at the option of either the company or
myself.
Proof of right to work and identity will be required if selected for hire.
Applicant's Signature Date