First Name (Required)

Middle

Last (Required)

Date of Birth (Required)

Email Address (Required)

Phone Number (Required)

Street Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Position(s) Applying for: (Line Cook, Prep Cook, Dishwasher, Food Runner) (Required)

Will this be your primary job? (Required)

Yes

No

When would you be able to start? (Required)

Last day you are available this season?

How did you find out about this job? (Required)

If you are under 18, can you furnish a work permit? (Required)

Yes

No

I am over 18

Have you been convicted of a felony? (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.) (Required)

Yes

No

If yes, state the nature of the offense and disposition of the case. Include dates and places.

List any special skills or training

Employer 1 (If Applicable)

Phone No. with Area Code

Address

Start Date

End Date

Job Title

Supervisor's Name & Title

Describe duties briefly

Specific reason for leaving

Employer 2: Company Name

Phone No. with Area Code

Address

Start Date

End Date

Job Title

Supervisor's Name & Title

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational and employment history. Furthermore, I understand that if I am hired, employment with this company is "at will", which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law. (Required)

Date (Required)

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Kitchen Employment