Employment Application

Applicant Information
Full Name:

Date:
Last

First

M.I.

Address:
Street Address

Apartment/Unit #

City

Phone:

State

(_____) _____-________

Social Security No:

E-mail Address:

______-_____-_______

Date Of Birth:
YES

ZIP Code

____________________________________
_____________________

NO

YES

Are you a citizen of the United States?

NO

If no, are you authorized to work in the U.S.?

YES

NO

YES

NO

Have you ever worked for this company?

If yes, when?

____________________________________

Have you ever been convicted of a felony?

If yes, please explain? ____________________________________________________________________________
Are you of legal age to serve alcoholic
beverages? (18 or older)

YES

NO

YES

NO

Have you ever been terminated from a job?

If yes, please explain? ____________________________________________________________________________

Position
Full Time

Part Time

Temporary

Are you seeking:

What position are you seeking?

Server

Available to begin work:

Hostess/Host

Bartender

Immediately

Cook

Busboy

Other Date: ______________

How did you hear about us? ____________________________________________________________________________

Please enter hours/days available to work:
Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

______ AM

______ AM

______ AM

______ AM

______ AM

______ AM

______ AM

______ PM

______ PM

______ PM

______ PM

______ PM

______ PM

______ PM

Total Hours Per Week: ____________

How much restaurant experience do you have?

Experienced

Some Experience

None

If you have some experience or you are experienced, please explain? ____________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Education & Training

High School:

__________________________

Address:

_______________________________________________
YES

From:

_________

College:

To:

________

NO

Did you graduate?

____________________________

Address:

Degree:

_______________________________________________
YES

From:

_________

To:

________

Other:

_________________________________

From:

_________

NO

Did you graduate?

Address:

Degree:

Special Training:
From:

From:

To:

________

To:

________

Address:

Did you graduate?

__________________________

_________

NO

Did you graduate?

__________________________

_________

Special Training:

________

Address:

Did you graduate?

_________________________

________________________________________________
YES

To:

_________________________

Degree:

__________________________

________________________________________________
Degree or
YES
NO
Certificate:
_______________________
________________________________________________
Degree or
YES
NO
Certificate:
_______________________

References
Please list three professional references.
Full Name:

____________________________________

Company:

__________________________________________________

Address:

Relationship:

_____________________________________
Phone:

(_____)_____-________

____________________________________________________________________________________________

Full Name:

____________________________________

Company:

__________________________________________________

Address:

Relationship:

_____________________________________
Phone:

(_____)_____-________

____________________________________________________________________________________________

Full Name:

____________________________________

Company:

__________________________________________________

Address:

Relationship:

_____________________________________
Phone:

(_____)_____-________

____________________________________________________________________________________________

Previous Employment
Company:

________________________________________________

Phone:

Address:

________________________________________________

Supervisor:

Job Title:

_________________________

Responsibilities:
From:

____________

Starting Salary:

$____________

(_____)_____-________
__________________________
Ending Salary:

$___________

________________________________________________________________________________
To:

_________

Reason for Leaving:

YES

May we contact your previous supervisor for a reference?

__________________________________________
NO

Company:

________________________________________________

Phone:

Address:

________________________________________________

Supervisor:

Job Title:

_________________________

Responsibilities:
From:

Starting Salary:

$____________

(_____)_____-________
__________________________
Ending Salary:

$___________

________________________________________________________________________________

____________

To:

_________

Reason for Leaving:

__________________________________________

YES

NO

May we contact your previous supervisor for a reference?

Company:

________________________________________________

Phone:

Address:

________________________________________________

Supervisor:

Job Title:

_________________________

Responsibilities:
From:

____________

Starting Salary:

$____________

(_____)_____-________
__________________________
Ending Salary:

$___________

________________________________________________________________________________
To:

_________

Reason for Leaving:

__________________________________________

YES

NO

May we contact your previous supervisor for a reference?

Military Service
Branch:

_____________________________________________________

Rank at Discharge:

_____________________________

If other than honorable, explain:

From:

Type of Discharge:

________

To:

_______________

______________________________

_______________________________________________________________________

Disclaimer and Signature

Please read carefully before signing.
I certify that the information given herein is true and complete to the best of my knowledge. I authorize Bottoms Up Sports Bar and Grill to investigate
any information, including my employment history, educational background, credit history and record of criminal convictions that it believes is relevant to
my employment application. My current and former employers, educational institutions, and personal references may provide information that they may
have about me in response to inquiry from the employer. I understand that any offer of employment by Bottoms Up Sports Bar and Grill is contingent
upon obtaining reference information learned through the above mentioned reference checks as well as upon the successful completion of a criminal
history and background check. I understand that omitting material fact and/or providing false or misleading information or misrepresentations in my
application, resume, or during the interview process may result in a refusal to hire, or discharge in the event of employment. I understand that I shall be
required to provide documentation establishing my legal authorization for employment within the first three days of my employment. I understand that if
employed, my employment will be at will and I will not have a guarantee of employment for any specific period of time unless otherwise provided in a
written employment agreement signed by the Company President/Owner and me. Bottoms Up Sports Bar and Grill is an Equal Opportunity Employer,
and shall treat all employees and all applicants for employment equally and fairly based upon job related qualifications and in accordance with all
applicable local, state and federal laws.

Signature:

Date: