CONTACT INFORMATION First Name*
Middle Initial
Last Name*
Phone*
Email*
Address
City
State
Zip
JOB DETAILS
Referred By AdvertisementAgencyPersonIn Store SignageWebsiteOther
Please Name Source (if answered other)
Are you legally eligible for employment in the USA? YesNo
Date of Birth*
Position applying for
Wage expectations
Do you have transportation to and from work? YesNo
PREVIOUS EMPLOYMENT WITH US
Were you previously employed by us YesNo
If yes, when
Other name(s) used while attending schools or places of employment indicated on this form
BACKGROUND
Can you perform the functions of this job with or without reasonable accommodations YesNo
If No, please explain
Have you ever been convicted of a felony YesNo
If yes, please explain (A conviction alone will not automatically bar you from employment)
EDUCATION
High School
Name and Location
Course of Study
Currently Enrolled YesNo
What year did you / do you plan to graduate
College
Degree
Other
MILITARY
Military Service YesNo
Branch of Service & Rank
Dates of Service
Special Training
EMPLOYMENT
Current / Most Recent Employer
Name of Company
Supervisor
Salary
Phone
Job Title
Date Started
Date Left
Job Description
Reason For Leaving. Still ThereLaid OffQuitFired
Explain
Second Most Recent Employer
Third Most Recent Employer
REFERENCES
First Reference
Name
Relationship to Reference
Occupation
Second Reference
Third Reference
ADDITIONAL INFORMATION
Please summarize any additional information necessary to fully describe your qualifications.
PLEASE READ All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts in this application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment offer is contingent upon satisfactory references and I authorize Heights Pub & Parlor to investigate past employment and education history, as well as references given on application.
I understand that if employed such employment may be terminated for just cause, or no cause, by management at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its management, and then only when in writing and signed by the management, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
I fully understand and agree to all statements above. I agreeI don't agree
Submit Application
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