Katie Lou’s Café
70 Main Street, Senoia, GA. 30276 Phone 770-599-1362

Application For Employment

 

This application form is intended for use in evaluating your suitability for employment. Please answer all questions completely and legibly. If a question is not applicable, indicate with N/A. If you need more space to explain your answer, add an extra piece of paper. False or misleading statements, whether oral or written, are grounds for refusal or termination of employment.

 

The Café is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Café complies with all applicable state and local laws governing nondiscrimination in employment.

 

This application is not an employment contract. Additional testing of skills and other job-related characteristics, as well as testing for the presence of illegal drugs in your body, may be required before an offer of employment is made. It is the policy of Katie Lou’s Café to conduct criminal background checks on all employees. Information obtained in a background check may be used to make decisions concerning refusal or termination of employment.

 

Personal Data:

Name    Last                     First                           Middle                      Social Security Number        Email Address

 
 

Home Phone                                                         Work Phone                                                                  Cell Phone

 
 

Please list your current address and two most recent addresses

Current            Street                                           City                            State                          Zip           Since (Mo/Yr)

 
 

         Street                                           City                            State                          Zip           Since (Mo/Yr)

 
 
 

         Street                                           City                            State                          Zip           Since (Mo/Yr)

 
 
 
 

Availability
 

You prefer: ____Full-Time ___Part-Time ____Either You Can Work ____Weekends _____Mornings ____Evenings ____Holidays

 

Please answer all of the following questions. When necessary use an extra sheet of paper to provide explanations:

1. Are you at least 18 years of age and legally eligible for work in the United States?________________________________

2. Will you work overtime when necessary?__________________________________________________________________

3. Do you have any work restrictions?_______________________________________________________________________

4. Have you ever been discharged or asked to resign from a job? If yes, explain____________________________________

________________________________________________________________________________________________________

5. Have you ever been convicted of or pled guilty to a felony or other crime? If yes, explain__________________________

________________________________________________________________________________________________________

6. Job I am applying for at Katie Lou’s Café: ____Chef _____Manager ___Server ___Kitchen Support ___Dishwasher

 
Education

High School Attended                                      City, County, State                                                     Did you earn a diploma?

 
 
 

Undergraduate College Attended                 City, County, State                                                     Did you earn a diploma?

 
 
 

Trade, Business or Other School Attended                 City, County, State                                   Did you earn a diploma?

 
 
                                                                                                                                                                                                                                          

Please List All Job Related Certificates and Recognition Awards

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
 
 
 
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Employment Experience

Most Recent Employer                                         City                                                                 Phone

 
 

Position Held                                                           Date From /To          Pay Rate                    Supervisor

 
 

Duties                                                                                        Reason For Leaving

 
 
 
 

Next Most Recent Employer                               City                                                                 Phone

 
 
 

Position Held                                                           Date From /To          Pay Rate                    Supervisor

 
 
 

Duties                                                                                        Reason For Leaving

 
 
 

Next Most Recent Employer                               City                                                                 Phone

 
 
 

Position Held                                                           Date From /To          Pay Rate                    Supervisor

 
 
 

Duties                                                                                        Reason For Leaving

 
 
 

It is our policy to contact all employers listed above for references. Please note below those employers listed above whom we may not contact.

____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

 

Have you ever served in any branch of the United States Military? If yes, list branch, date of service (from / to):

____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
 

Do you have a valid driver’s license?   Y / N       Driver’s License Number                                              State of Issue

 
 
 

Have you ever been convicted or pled guilty to a traffic related offense within the past 5 years? Please list:______________________________________________

Have you ever had your drivers license suspended or revoked?   __Y___N If yes, explain____________________________________________________________

Please use this space to list any special skills you may have that relate to the position applied for:_________________________________

___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

Certification: Please verify the information you provided is correct and complete. I understand that employment is solely on an at-will basis and that my employment relationship may be terminated without notice by me or Katie Lou’s Café. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand it is the policy of Katie Lou’s Café to submit all employees to a criminal background check. I agree to this background check and understand that I may be terminated based on its results. 

__________________________                       _____

Signature                                                                                Date