Back Street Grill Salisbury Information


	Personal Information


First Name*				Last Name*
Address*
Address2
City*		St*		Zip*
Phone*				Cell
Email*
Referred By


	Employment Desired


Position		Earliest Start Date		Salary Desired


Are you employed now*	YesNo
May we contact your employer	YesNo
Are you legally authorized to work in the US*	YesNo
Ever applied to this company before?*	YesNo
Current availability


Where		When


	Education History


			Name		Location		Did you graduate		Years Attended		Subject Studied
	High School						YesNo
	College						YesNo
	Trade, Business, or Correspondence School						YesNo



	General Information


	Subject of special study/research work

	Special training

	Special skills



	Former Employers

Start Date

End Date

Name

Address

Salary

Position

Reason for Leaving


	Prior Restaurant Experience



	References


	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 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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