Shakers Restaurant Lynchburg Employment Application

APPLICANT INFORMATION
Last Name:
First:
M.I:
Today's Date:
Street Address:
Apt/Unit #:
City:
State:
Zip:
Cell Phone:
Email Address:
Position(s) Applied For:
Birthday:
Are you a citizen of the United States? YesNo
If no, are you authorized to work in the US? YesNo
Have you ever worked for this company? YesNo
If so, when?
Have you ever been convicted of a felony? YesNo
If yes, explain:
EDUCATION
High School
Address:
From:
To:
Did you graduate? YesNo
Degree:
College
Address:
From:
To:
Did you graduate? YesNo
Degree:
Other
Address:
From:
To:
Did you graduate? YesNo
Degree:
REFERENCES
Please list three references other than relatives & former supervisors. Please include their contact number.
Full Name:
Relationship:
Company:
Phone:
Email Address:
Full Name:
Relationship:
Company:
Phone:
Email Address:
Full Name:
Relationship:
Company:
Phone:
Email Address:
PREVIOUS EMPLOYMENT
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your supervisor for a reference? YesNo
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your supervisor for a reference? YesNo
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your supervisor for a reference? YesNo
AVAILABILITY
Do you have open availability? YesNo
If you answered no to the previous question, please list your availability.
DISCLAIMER & SIGNATURE

I certify that all 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.

Signature / Initial (Please put your initials below to act as your signature)
Date: