Now Hiring – Butts-n-Such

Name *

First

Last

Social Security Number/Federal Government ID *

I agree to provide my SS#/Federal Government ID to the hiring manager during my interview as I understand that it is not required to complete an online application, but will be required to obtain employment.

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Street Address *

City *

State *

Zip *

Phone Number *

Secondary Phone Number (if available)

Email *

Referred by?

Position Applying For (you can select more than one) *

Servers/Front of House
Dishwashers

Date you can start *

Are you employed now? *

Yes
No

If so, may we inquire of your present employer? *

Yes
No

Have you ever applied to work here or have you worked here before? *

Yes
No

High School Attended (or attending) *

Did you graduate? *

Yes
No
Currently in High School
I have a GED

Did you attend college/technical school?

List any college/technical schools attended (if applicable)

U.S. Military or Naval Service (if applicable)

Current Military Status (if applicable)

Active
Retired
Guard/Reserve
Veteran

Current or Most Recent Employer

Dates Employed

Position

Reason for Leaving

Former Employer #2

Dates Employed at Employer #2

Position at Employer #2

Reason for Leaving Employer #2

Former Employer #3

Dates Employed at Employer #3

Position at Employer #3

Reason for Leaving Employer #3

Former Employer #4

Dates Employed at Employer #4

Position at Employer #4

Reason for Leaving Employer #4

Reference #1 *

Reference #2 *

Reference #3 *

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissial. *

Yes, I agree.

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I authorize investigation of all statements contained herein and the references and employers listed above to give you and and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. *

Yes, I agree.

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I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. *

Yes, I agree.

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This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by Americans with Disabilities Act (ADA) and other relevant federal and state laws. *

Yes, I agree.

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I understand that a background check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of the reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that violations on my report will not necessarily disqualify me from employment. *

Yes, I agree.

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In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification documentation form upon hire. *

Yes, I agree.

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ELECTRONIC SIGNATURE *

Please type your name and date in the box above as authorization and agreement to this job application.