PERSONAL INFORMATION

DATE

NAME

ADDRESS

CITY, STATE, ZIP

PHONE     (home)   (cell)         

e-mail

REFERRED BY

ARE YOU LEGALLY ABLE TO WORK IN THE UNITED STATES? yes       no
(PROOF OF IDENTITY AND LEGAL AUTHORITY TO WORK IN THE U.S. IS A CONDITION OF EMPLOYMENT)

ARE YOU OF LEGAL AGE TO SERVE ALCOHOL IN THIS STATE? yes       no

ARE YOU TIPS OR TAM CERTIFIED yes       no

HAVE YOU EVER BEEN CONVICTED OF A FELONY WHICH HAS NOT BEEN
ANNULLED, ERASED, EXPUNGED, VACATED, SET ASIDE OR SEALED BY THE COURT? yes       no

EMPLOYMENT DESIRED

POSITION

START DATE

FOR SEASONAL APPLICANTS: START DATE END DATE

ARE YOU CURRENTLY EMPLOYED? yes       no

IF SO, MAY WE INQUIRE OF YOUR CURRENT EMPLOYER? yes       no

HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE? yes       no         

WHEN?

FORMER EMPLOYERS

FROM TO

NAME & ADDRESS OF EMPLOYER

SALARY POSITION REASON FOR LEAVING

FROM TO

NAME & ADDRESS OF EMPLOYER

SALARY POSITION

REASON FOR LEAVING

FROM TO

NAME & ADDRESS OF EMPLOYER

SALARY POSITION

REASON FOR LEAVING

EDUCATION

NAME & LOCATION OF SCHOOL

YEARS ATTENDED     DID YOU GRADUATE? yes     no     

SUBJECTS STUDIED

NAME & LOCATION OF SCHOOL

YEARS ATTENDED     DID YOU GRADUATE? yes     no     

SUBJECTS STUDIED

REFERENCES

NAME         

ADDRESS

BUSINESS   YEARS KNOWN

NAME         

ADDRESS

BUSINESS   YEARS KNOWN

NAME         

ADDRESS

BUSINESS   YEARS KNOWN

AUTHORIZATION

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 (or current) 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 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.

I have read and agree with this Authorization