Employment Application

Name*
First Middle Last
Your Phone
Your Email*
Your Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Which position are you applying for?
Availability
- Days
- Evenings
Capacity
- Part-time
- Full-time
- Temporary/PRN

References (Cannot be related to you or a previous employer.)
Reference - 1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Reference - 2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Reference - 3
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone

Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Employment - 1
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Job Title
Supervisor
Reason for Leaving
Date Began
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Starting Rate
Final Rate
Work Performed/Responsibilities:
Employment - 2
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Job Title
Supervisor
Reason for Leaving
Date Began
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Starting Rate
Final Rate
Work Performed/Responsibilities:
Employment - 3
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Job Title
Supervisor
Reason for Leaving
Date Began
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Starting Rate
Final Rate
Work Performed/Responsibilities:

Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experiences.
If you were unemployed at any time since leaving school, please indicate what you were doing during this time.
Applicant's Statement & Agreement

By submitting this application, I hereby authorize the employers listed above to release all information to Pepper's Grill and Sports Pub . I also understand that this authorization is valid for 60 days. I waive any liability to the employers listed above, and its employees, from any claims of action for disclosure of information that could adversely affect any new employment opportunity.

I certify that the above information is true and correct and give authorization for investigation of all statements and information contained in this application, my resume, and other documents or verbally obtained information obtained during an employment interview. I voluntarily consent to allow Pepper's Grill and Sports Pub or any of their representatives or agents to check my references by contacting any persons, company or governmental entity they deem to be an appropriate reference. I understand that references questions may pertain to my personal or educational background, work experiences, character and behavior. I understand my employment is subject to satisfactory verification of this information and agree that deliberate falsification of this document or significant omissions shall be grounds for employment consideration disqualification or dismissal from employment, if discovered at a later date. I pledge, if hired, to comply with the guidelines of conduct and company policies and procedures of Pepper's Grill and Sports Pub. I also realize that company policies, procedures, practices or statements made during an interview or employment do not create an employment contract by implication or otherwise. I further understand and agree that my employment is for no definite period of time and may, regardless of time and manner, be terminated by the company or myself with or without cause or previous notice. I understand that employment may be subject to satisfactory completion of physical examination and/or drug screening.

I understand that, if hired, I am entering into a co-employment relationship whereas Pepper's Grill and Sports Pub is my worksite and directing employer. This application will be kept in a current file for thirty days. If not contacted during that period of time, it may be necessary to complete another application to receive further employment consideration.

Step 1 of 6

References (Cannot be related to you or a previous employer.)

Reference - 1

Reference - 2

Reference - 3

Education: High School

Education: Trade School

Education: College/University

Education: Additional Schooling

Employment Experience

Employment - 1

Employment - 2

Employment - 3

Applicant's Statement & Agreement