Web Site Name * Please enter your first and last name. Today's Date * Your Address * Are you at least 18 years of age? * Yes No E-Mail Address * Primary Phone * Secondary Phone Position Desired * Are you currently employed? If yes, please list your current employer[s] Availability * Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Sunday AM Sunday PM Please select all that apply. Please list your most recent restaurant job. Name of Employer Supervisor May we contact your previous employer/supervisor? Yes No Previous employer's address Previous employer's phone number Dates of employment: From when to when? Please write the month/year of the beginning of your employment to the month/year you left or "Present" if you're still there. Reason for leaving Please list your primary responsibilities are your previous/current job. If you are applying for a service position, please list 5 points of service that you believe to be the most important. AUTHORIZATION I authorize investigation of all statements contained herein. and the references and employers listed above to give any and all pertinent information they may have, personal or otherwise and release the company from all liability from any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. BY TYPING MY NAME BELOW, IN ACCORDANCE WITH THE ESIGN ACT OF 2000, I AGREE TO ALL OF THE TERMS AND CONDITIONS LISTED ABOVE. By printing my FULL NAME below, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.