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Name:

Email Address:

Phone:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Position(s) Applied For:

Are you a citizen of the United States?YesNo

Have you ever worked for this company?YesNo

Have you ever been convicted of a felony?YesNo

Education

High School

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

From

Did you graduate?YesNo

Degree

College

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

From

Did you graduate?YesNo

Degree

Other

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

From

Did you graduate?YesNo

Degree

References - Please list three references other than relatives & former supervisors. Please Include their contact number

Name

Email Address

Company

Phone

Relationship

Name

Email Address

Company

Phone

Relationship

Name

Email Address

Company

Phone

Relationship

Previous Employment 1

Company:

Phone:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Supervisor:

Starting Salary

USD

Ending Salary

USD

Job Title:

Responsibilities:

To:

From:

Reason for Leaving:

May we contact your supervisor for a reference?

Previous Employment 2

Company:

Phone:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Supervisor:

Starting Salary

USD

Ending Salary

USD

Job Title:

Responsibilities:

To:

From:

Reason for Leaving:

May we contact your supervisor for a reference?

Previous Employment 3

Company:

Phone:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Supervisor:

Starting Salary

USD

Ending Salary

USD

Job Title:

Responsibilities:

To:

From:

Reason for Leaving:

May we contact your supervisor for a reference?

Availability

Do you have open availability?YesNo

If you answered no the previous question, please list your availability:

Disclaimer & Signature

I certify that all my answers are true 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:

Shakers Lynchburg

Nutritional & Dietary Information

Shakers Restaurants have a menu with a wide selection of foods, and we are always happy to work with our customers to accommodate any special requests or dietary needs.

*Health Advisory: Consuming raw or under-cooked meats, poultry, seafood,
shellfish or eggs may increase your risk of food borne illness.

Roanoke Employment Application

Shakers Lynchburg

Nutritional & Dietary Information

Shakers Roanoke