Employment (* = required) Personal Information Name * Address * City * State * Zip code * Phone number * Referred by Are you 18 years of age or older? * Yes No If not 18, indicate age Do you have legal right to work in US? * Yes No Employment Desired Position * Date you can start * Wage desired * Are you employed? * Yes No If so, may we contact your present employer? * Yes No Have you applied at the Tavern before? * Yes No If so, when? Have you ever been convicted of a crime, Received Deferred Adjudication, pled no contest, or been placed on probation for a crime? * Yes No Education Background Name and Location of School Years Did You Graduate? Subjects Studied High School Yes No College Yes No Other Yes No Former Employers List below last three employers, starting with the last one first. Employment Dates Name and Address of Employer Salary/Wage Position Reason for Leaving From: To: From: To: From: To: Availability Please check each day by shift. Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day (until 5pm) Yes No Yes No Yes No Yes No Yes No Yes No Yes No Night Yes No Yes No Yes No Yes No Yes No Yes No Yes No Do you live in this area year round? * Yes No
