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Personal Information
First Name*Last Name*
Address*
Address2
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Email*
Referred By
Employment Desired
PositionEarliest Start DateSalary Desired
Are you employed now*
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Are you legally authorized to work in the US*
Ever applied to this company before?*
Current availability
WhereWhen
Education History
NameLocationDid you graduateYears AttendedSubject Studied
High School
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Trade, Business, or
Correspondence
School

General Information
Subject of special study/research work
Special training
Special skills

Former Employers
Start DateEnd DateNameAddressSalaryPositionReason for Leaving
Prior Restaurant Experience

References
NameAddressBusinessYears 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 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.


*I have read the above policies, understand their implications and agree to abide by the policies set forth.


Name*Date*
 


Back Street Grill Salisbury
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