Name

Social Security Number:

Home Address

Phone

Person To Notify In An Emergency 
Name Phone

Are You Applying For  A Position: Fulltime  Part-time

If Part-time, # Of Shifts Per Week: Hours Per Week

Restaurant Location You'd Prefer:  Somersworth Lee Either

Position Applied For: Dishwasher Prep Cook Line Cook Waitperson Bus Person Cashier Host/Hostess

When Are You Able To Start?

Days You Are Available To Work:
Everyday Sun  Mon Tues Wed Thurs Fri Sat

Hours You Are Available To Work

Are You At Least 19 Years Of Age? Yes No

If Under 19, Date Of Birth

Your Work Experience

Please list your last 3 jobs (Start With Most Recent)

1.  Employer

Your Job Title

Employment Dates:  From To

Supervisor Title

Reason For Leaving

2.  Employer

Your Job Title

Employment Dates:  From To

Supervisor Title

Reason For Leaving

3.  Employer

Your Job Title

Employment Dates:  From To

Supervisor Title

Reason For Leaving

Is It Alright To Contact Your Former Employers? Yes  No

Your Education

1.  High School  Diploma Yes No

2. Vocational-Trade School   Yes No

3. College   Yes No

Do You Possess Any Other Restaurant Experience?  
Include Restaurant Name, Location, Your Title And Dates Of Employment.

List Three References Other Than Relatives Or Work Supervisors Whom We May Contact:

Name/Address/Phone

1.

2.

3.