* Asterisk denotes a required field
----------------------------------------------------------- APPLICANT INFORMATION ----------------------------------------------------------- Name* Phone* Email* Address* City, Zip*
How were you referred to Company? Location Applying for:* Dallas on Walnut StCarrolltonArlingtonHoustonFort WorthThe ColonyDeep EllumEl PasoMidland (coming later) Position(s) applying for:* Kitchen StaffServer / Bartender / HostManagement
Applying for:* Temporary WorkPart timeFull time What days and hours are you available for work?* If hired, on what date can you start working? Can you work on: WeekendsEveningsOvertime Salary / Wage desired:
----------------------------------------------------------- PERSONAL INFORMATION ----------------------------------------------------------- Have you ever applied to / worked for this Company before? YesNo If yes, please explain
Do you have any friends, relatives, or acquaintances working for Company? YesNo If yes, state name & relationship
If hired, would you have transportation to/from work? YesNo
Are you over the age of 18?* (All staff are required to provide a copy of their driver’s license) YesNo
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?* YesNo
If hired, are you willing to submit to and pass a controlled substance test? YesNo
Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? YesNo If no, describe the functions that cannot be performed.
Have you ever been convicted of a criminal offense (felony or misdemeanor)? YesNo If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.
Do you speak, write or understand any foreign languages? YesNo If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be.
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? YesNo If yes, please explain.
----------------------------------------------------------- EDUCATION, TRAINING, EXPERIENCE ----------------------------------------------------------- High School Name: Address: City, state, zip: Number of years completed: Did you graduate? YesNo Degree / diploma earned:
College / University Name: Address: City, state, zip: Number of years completed: Did you graduate? YesNo Degree / diploma earned:
Vocational School: Name: Address: City, state, zip: Number of years completed: Did you graduate? YesNo Degree / diploma:
Military: Branch: Rank in Military: Total Years of Service: Skills/duties: Related details:
----------------------------------------------------------- EMPLOYMENT HISTORY ----------------------------------------------------------- Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed. Are you currently employed? YesNo If you are currently employed, may we contact your current employer? YesNo
Name of Employer: Name of Supervisor: Telephone Number: Business Type: Address: City, state, zip: Length of Employment (Include Dates): Position & Duties: Reason for Leaving: May we contact this employer for references? YesNo
----------------------------------------------------------- EMPLOYMENT HISTORY ----------------------------------------------------------- List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.
Name - First, Last: Telephone Number: Address: City, state, zip: Occupation: Number of Years Acquainted:
Please Read and Check Each Paragraph I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.
I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
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