Dutch Kitchen Restaurant

*Full Name:

*Street Address:

*City, State, & Zip

*Home Phone:

Mobile Phone:

Email:

*Are you either a U.S. citizen or an alien authorized to work in the U.S.?

Yes No

*Are you at least 16 years of age or over?

Yes No

*Date you can start work:

Salary / Wage Desired:

*Are you employed now?

Yes No

If so, may we contact your present employer?

Yes No

*Have you ever worked for Dutch Kitchen before?

Yes No

If so, when?

Education Information:

Name and location of High School and years attended:

Did you graduate?

Yes No

Name and location of College / University and years attended:

Did you graduate?

Yes No

EMPLOYMENT HISTORY:

List below your last three employers, starting with the most recent first.

Previous Employer 1: List Name, Location, Start and End Dates, Rate of Pay, Position/Duties, and Reason for Leaving:

Previous Employer 2: List Name, Location, Start and End Dates, Rate of Pay, Position/Duties, and Reason for Leaving:

Previous Employer 3: List Name, Location, Start and End Dates, Rate of Pay, Position/Duties, and Reason for Leaving:

REFERENCES

Give the names of three persons not related to you, whom you have known for at least one year. Please list the Name, Contact Info, Business, and Years Acquainted for each:

About Yourself:
What sports, activities, and hobbies do you enjoy?

*I have read and agreed to the statements below regarding truth in application, investigation of my statements and period of employment.

Yes No

Truth in Application Statement:

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 dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.

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EmployMENT Application

Truth in Application Statement: