Home Phone Work Phone Cell PhoneApplication 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)
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
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
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