First Name
Last Name
Date of Birth
Street Address
City
State
Zip Code
Phone Number
Email Address
ARE YOU ELIGIBLE TO WORK IN UNITED STATES? YesNo
IF YOU ARE UNDER AGE 18, DO YOU HAVE AN EMPLOYMENT/AGE CERTIFICATE? YesNo
HAVE YOU EVER BEEN CONVICTED OF OR PLEADED NO CONTEST TO A FELONY WITH THE LAST FIVE YEARS? YesNo
IF YES, PLEASE EXPLAIN
HEALTH CARD Yes
TAM CARD (ALCOHOL AWARENESS CARD) Yes
POSITION APPLIED FOR Busser/Food RunnerLine CookHostessServerBartender
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
WHAT DATE ARE YOU AVAILABLE TO START WORK?
NAME AND ADDRESS OF SCHOOL-DEGREE/DIPLOMA-GRADUATION DATE
SKILLS AND QUALIFICATIONS: LICENSES, SKILLS, TRAININGS, AWARDS
EMPLOYER
ADDRESS
PHONE
POSITION TITLE
START DATE
END DATE
RESPONSIBILITIES
REASON FOR LEAVING
PLEASE UPLOAD PICTURE FOR REFERENCE