Name *

First Name

Last Name

Phone Number *

(###)

###

####

Referred By

First Name

Last Name

Position *

Select all that apply

Barback

Bartender

Busser

Cocktail Server

Dishwasher / Cleaner

Door Host

Food Runner

Line Cook

Line Dance Instructor

Security

Server

Date Available to Start *

MM

DD

YYYY

What Days Are You Available To Work? *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

If Hired, On What Date Can You Start Working? *

MM

DD

YYYY

I certify that I have not purposely withheld any information that might adversely affect my chance for hiring. I attest to the face that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection or, if I am employed by this company, terms for my immediate expulsion from the company. *

First Name

Last Name

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company. *

First Name

Last Name

I permit the comapany to examine my references, record of employment, education record, and any other information that I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other person, corporoation, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation. *

First Name

Last Name

I HAVE READ, UNDERSTOOD AND AGREE TO ALL THE INFORMATION LISTED ABOVE *

First Name

Last Name

Date *

MM

DD

YYYY