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PERSONAL INFORMATION:
First Name _____________________________
Last Name _____________________________
Local Address
_______________________________________________________
Permanent Address
_______________________________________________________
Phone Number
(___)___________________________________
Are you under the age of 18?
Yes ___ No ___
Have you been convicted of or pleaded no contest to a felony within the
last five years?
Yes_______ No_______
If yes, please explain: _________________________________________
_________________________________________
POSITION/AVAILABILITY:
Position Applied For
________________________________________
Days Available
Monday ____
Tuesday ____
Wednesday ____
Thursday ____
Friday ____
Saturday ____
Sunday ____
Hours Available: from _______ to ______
How many hours a week?_____________
What date are you available to start work?
________________________________________
What date is the last day you can work?
________________________________________
Can you work?
Memorial Day weekend_____________
July 4th weekend__________________
Labor Day weekend________________
Planned days you can not work? _________________________
EDUCATION:
Name and Address Of School - Degree/Diploma - Graduation Date
_________________________________________________________________
_________________________________________________________________
EXPERIENCE:
Present Or Last Position:
Employer:
_____________________________________________________
Address:______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Email: ________________________________
Position Title: _________________________
From: ______________ To: ______________
Responsibilities:
____________________________________________________
__________________________________________________________
Salary: _______________
Reason for Leaving:
____________________________________________
Previous Position:
Employer: _____________________________________________________
Address:______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Email: ________________________________
Position Title: _________________________
From: ______________ To: ______________
Responsibilities__________________________________________
__________________________________________________________
Salary: _______________
Reason for Leaving:
____________________________________________
May We Contact Your Present Employer?
Yes _____ No _____
References:
Name/Title Address Phone
1)_________________________________________________________________
2)_________________________________________________________________
3)_________________________________________________________________
Will this be your only job?______________________
How did you hear about Salad Factory?_____________________________
Why do you want to work here?
__________________________________________________________________
__________________________________________________________________
I certify that information contained in this application is true and complete.
I understand that false information may be grounds for not hiring me or for immediate termination of employment at any
point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature______________________________
Date__________________________________
FOR OFFICE USE ONLY:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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