Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile Phone *

(###)

###

####

Are you legally allowed to work in the U.S.? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Are you willing to submit to a pre-employment drug screening, if selected for employment? *

Yes

No

Position Desired *

Check all that apply:

Bartender

Porter

Available Start Date *

MM

DD

YYYY

Employment Desired *

Full Time

Part Time

Days Available *

Check all that apply:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Times Available *

Check all that apply:

Morning (8am start time)

Afternoon (12/1pm start time)

Evening (3/4/5pm start time)

Whenever, I'm flexible

Did you graduate?

Yes

No

If no, please select one of the following:

I'm still attending high school

I earned my GED

None of the above

Did you graduate?

Yes

No

Did you graduate?

Yes

No

Employer 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer 1 Phone

(###)

###

####

Employer 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer 2 Phone

(###)

###

####

Employer 3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer 3 Phone

(###)

###

####

Reference 1 *

First Name

Last Name

Reference 1 Phone *

(###)

###

####

Reference 2

First Name

Last Name

Reference 2 Phone

(###)

###

####

Reference 3

First Name

Last Name

Reference 3 Phone

(###)

###

####

Acknowledgment *

By signing + submitting this application for employment, you certify that your answers are accurate + complete to the best of your knowledge. If hired, you understand that giving false, misleading, or incomplete information in this application or during the interview process may result in your release from employment.

Everything I've entered in the form above is true + accurate to the best of my knowledge.

Date Signed + Submitted *

MM

DD

YYYY