The Heights Cafe Employment Application

The Heights Cafe
Employment Application
We are an Equal Opportunity Employer dedicated to a policy
of nondiscrimination in employment on any prohibited basis
including race, color, age, sex, handicap, sex religion, or
national origin.
PERSONNEL
NAME:
last
first
middle
PERMANENT ADDRESS:
PHONE NUMBER: (
)
PERMANENT NUMBER: (
SOCIAL SECURITY #
)____________________
Are you 18 or older? Y / N
Legally able to work in the U.S.? Y / N
GENERAL
Other than a minor traffic violation, have you been convicted of a criminal offense? Y / N
If yes, Charge:
Place:
Date:
AVAILABILITY
Position desired:
FT / PT
______________________________________________________________________________________________________
Date you can start:
Salary desired:
______________________________________________________________________________________________________
Although you may be hired for a specific shift, business necessity may require that you work overtime or different hours or
days. Is this acceptable to you? Y / N
EDUCATION
Circle Last
Year
Completed
1234
Did You
Graduate?
College
1234
Y/N
Other (Trade)
1234
Y/N
Other
1234
Y/N
High School
Name & Location of School
Y/N
Subject Studied
Degree(s) Received
SPECIAL SKILLS
EMPLOYMENT HISTORY
Account for all periods of employment and list periods of unemployment for the last six years beginning with your present or
most recent position. All information including salary will be verified.
May we contact your present employer? Y / N
FROM
TO
NAME/ADDRESS
NAME & TITLE OF
SUPERVISOR
POSITION
SALARY
REASON
FOR
LEAVING
REFERENCES
Give the names of three persons not related to you, whom you have known for at least one year.
NAME
ADDRESS
PHONE
YEARS KNOWN
PLEASE READ THIS STATEMENT CAREFULLY
I understand that employment with The Heights Cafe is at will, and that either The Heights Cafe or I can terminate this
employment relationship at any time, for any reason, with or without notice and with or without cause. I further understand
that neither this application nor any other written or oral communication I may receive from The Heights Cafe or any of its
employees constitutes or creates a contract of employment.
I authorize The Heights Cafe to contact any or all of my former employers listed herein and to inquire about my employment
there. I release The Heights Cafe and any employer who is contacted from any liability arising out of such inquiry or the
response to such inquiry.
I certify that the statements contained herein are true to the best of my knowledge and belief. I understand that if I am
employed by The Heights Cafe, any false or misleading statement on this application or during the course of any employment
interview, may result in discipline up to and including immediate discharge.
Signature
Date