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Personal Information |
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First Name:
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Last Name: |
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Middle Name: |
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Email:
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Phone Number: |
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Are you over 18? |
Yes
No |
Are you over 21? |
Yes
No |
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| Present Address: |
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City: |
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State: |
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Zip Code: |
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| Mailing Address: |
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City: |
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State: |
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Zip Code: |
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Have you applied at any
of these locations in the past?
Coffee Cup
Cafe
A Second Cup
Cowboy
Cafe
Chuck Wagon
Family Grill
None
of the above
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How were you referred to us?
If by Friend or
Employee, who?
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Select all that apply; use CTRL-click to
select |
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| Are you legally able to work
in the United States? Yes
No |
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Have you ever been convicted of a felony?
Yes
No |
Have you ever been convicted
of any drug or alcohol related charge? Yes
No |
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Employment Desired |
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| Position: |
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Date you can
start: |
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Salary Desired: |
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| Are you employed?
Yes
No |
If so, may we contact your
present employer? Yes
No |
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| Former
Employers |
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Date
Month and Year |
Employer Information |
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From:
To:
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Name of Employer:
Address of Employer:
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Salary:
Position:
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Reason for leaving:
Name of Supervisor:
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From:
To:
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Name of Employer:
Address of Employer:
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Salary:
Position:
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Reason for leaving:
Name of Supervisor:
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From:
To:
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Name of Employer:
Address of Employer:
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Salary:
Position:
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Reason for leaving:
Name of Supervisor:
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Education History |
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High School:
College: |
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Years Attend:
Years Attend: |
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Did you
graduate?
Did you graduate? |
Yes
No
Yes
No |
Subjects studied:
Subjects studied: |
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References |
Give below the names of three
persons not related to you, whom you have know at least one
year. |
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Name
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Phone Number
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Business
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Years Known
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| Days
and Hours of Availability |
Check the days you are
available to work and enter the hours you are available,
hours range from 5:30am until 2:00am. |
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Monday
From:
To:
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Tuesday
From:
To:
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Wednesday
From:
To:
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Thursday
From:
To:
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Friday
From:
To:
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Saturday
From:
To:
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Sunday
From:
To:
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Interested in -
Full
Time
Part
Time |
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Please enter any further information you would like
us to know.
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Authorization |
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By click on the "Submit"
button "I certify that the facts contained in this
application are true and complete to the best of my
knowledge and understand that, if employed, falsified
statements on this application shall be grounds for
dismissal.
I authorize investigation of all statements contained herein and
the references and employers listed above to give you any
and all information concerning my previous employment and
any pertinent information they may have, personal or
otherwise, and release the company from all liability for
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 period of time, or to make any agreement
contrary to the foregoing, unless it is in writing and
signed by an authorized company representative.
This waiver does not permit the release or use of
disability-related or medical information in a manner
prohibited by the Americans with Disabilities Act (ADA) and
other relevant federal and state laws." |
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