General Information
First Name
Last Name
Address
City
State
Zip
Phone
E-mail Address
Social Security Number
Are you over 18 years of age
yes no
Desired Start Date
How did you hear about employment at Grits Cafe
Is there any work you will not perform
Are you eligible to work in the United States:
yes no
Position Applying for
Have you ever been convicted of a crime
yes no
If Yes, Explain
Are you available to work full time (36 hours or more per week)
yes no
Are you available to work part time (Less than 36 hours a week)
yes no
When would you like to work (check all that apply)
Days Evenings Weekends Midweek
What unique qualifications, skills or experience would you bring to Grits Cafe
Why would you like to work at Grits Cafe
Do you belong to any professional, educational or civic organizations (Please exclude those which may disclose your race, color, religion or national origin)
Were you ever fired
yes no
If yes, why
Education
High School name and address
Course of study
Number of years
1 2 3 4
Did you graduate
yes no
Degree earned
College / Vocational School name and address
Course of study
Number of years
1 2 3 4
Did you graduate
yes no
Degree earned
Employment History
(Please start with your present or most recent position)
Employer
Phone
Address
Supervisor's Name and Title
Starting date
Ending date
Weekly rate
Describe the type of work you did
Explain your reason for leaving
May we contact this employer
yes no
If no, explain
Employer
Phone
Address
Supervisor's Name and Title
Starting date
Ending date
Weekly rate
Describe the type of work you did
Explain your reason for leaving
May we contact this employer
yes no
If no, explain
Employer
Phone
Address
Supervisor's Name and Title
Starting date
Ending date
Weekly rate
Describe the type of work you did
Explain your reason for leaving
May we contact this employer
yes no
If no, explain
Professional References
Name/Title
Phone
Organization
Address
Association with you
Name/Title
Phone
Organization
Address
Association with you
Name/Title
Phone
Organization
Address
Association with you
Please Read
I promise that the information in this employment application is true and complete, and I understand that any false or misleading information or significant omissions may disqualify me from further consideration for employment, and may lead to my dismissal from employment, if discovered at a later date. I agree to notify Grits Café immediately should I be convicted of a felony, while my job application is pending, or while employed by Grits Café if hired. I authorize any person mentioned in this employment application to provide Grits Café with any information requested in connection with the application and I release such persons from any legal liability in making such statements. I understand that if hired, I am obliged to comply with any and all Grits Café policies. I understand and agree that, if hired, my employment is for no definite time, and may be terminated at any time, with or without notice. As part of your application for employment, you are being asked to sign a release of information authorization. This is to allow Grits Café to verify your references, to perform other background investigations to determine your qualifications for employment.
I acknowledge to have read all of the above
yes no
Application date
