PERSONAL DATA

Name *

Present address

How long at present address?

Telephone #

When available To Start?

If under 18, please list age

Hourly wage desired $

Social Security No

Do you have Transportation to work?    YES  NO

How many hours can you work weekly?  

Employment desired  FULL-TIME ONLY PART-TIME ONLY FULL-TIME OR PART-TIME

EDUCATION

HAVE YOU EVER BEEN CONVICTED OF A CRIME?  Yes No

If YES, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Work Experience

Please list your work experience for the past year beginning with your most recent job held.
If you were self-employed, give firm name. Attach additional sheets if necessary.

May we contact your present employer?  Yes No

Did you complete this application yourself ? Yes No

REFERENCES

Please list two references other than relatives or previous employers.

I further understand that my employment with Your Mothers House Kitchen & Bar shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with Your Mothers House Kitchen & Bar is terminable at will for any reason by either party.

Date: