Online Application

Instructions

Position you are applying for:	Today's Date:
First Name: M.I. Last Name:
Address 1: Address 2: City: State: Zip Code:	Email Address: Telephone Number: ( ) -
Date of Birth (if under 21):	Social Security Number: - -
I am applying for a: full time position part time position seasonal position

Employment History - starting with your most recent job

Employer's Name Address, Phone #	From (mm/yy)	To (mm/yy)	Your Position	Supervisor	Wage	Reason for Leaving
	/	/
	/	/
	/	/
	/	/
	/	/
	/	/

Educational History

School	Name and Location	Highest Grade Completed	Type of Degree/Certificate	Date of Leaving (mm/yy)
High		9 10 11 12 GED		/
Trade		1 2 3 4 none		/
College		1 2 3 4 none		/
Post Graduate		1 2 3 4 none		/

Personal Information

Are you authorized to work in the U.S.A.? yes no	Have you participated in an Alcohol Service Awareness Program? yes no If yes, what program? When does your certification expire (mm/yy)? /
Have you ever been convicted of a crime? yes no If yes, what crime and where?	Do you own a car? yes no How will you get to work?
Do you have any physical or mental ailments that would interfere with the performance of your duties?

Personal Interests

Hobbies, Interests, or Special Skills:	List any awards or honors you have received:
Extra-Curricular Activities (scholastic or athletic)	List any leadership positions you have held:

General Information

If hired, what date can you start work (mm/dd/yy)? / /

When are you available to work?

Sundays
yes
no

Weekdays
yes
no

Week Nights
yes
no

Weekends
yes
no

Holidays
yes
no

If there is a shift you are not able to work, please explain why:

Any other comments you want considered with your application?

BY SUBMITTING THIS FORM, I CERTIFY THAT ALL STATEMENTS GIVEN ON THIS APPLICATION ARE CORRECT, AND REALIZE THAT FALSIFICATION OR MISREPRESENTATION OF THIS OR ANOTHER PERSONAL RECORD MAY RESULT IN MY DISCHARGE.