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: