Proud Mary's Restaurant

Page 1 - Personal Information

Full Name: (first, middle, last) *

SSN #: *

Address 1 *

Address 2

City *

State *

Zip *

Primary Phone #: *

( )

-

Secondary Phone #:

( )

-

E-mail: *

Are you applying for:

Full TimePart TimeTemporary

Are you eligible to work in the United States? *

YesNo

Have you ever been convicted of a felony? *

YesNo

Explain:

Do you consent to a background check? *

YesNo

Page 2 - Education

High School

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Location:

Dates Attended

From:

To:

Did you graduate? YesNo

Did you receive your GED? YesNo

College

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Dates Attended

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Field of Study

Did you graduate? YesNo

Degree:

Vocational / Trade School

Name:

Location:

Dates Attended

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Field of Study

Did you graduate? YesNo

Degree / Certificate:

Other education

Page 3 - Experience

Are you currently employed?

YesNo

On what date will you be available to work?

May we contact your previous employers?

YesNo

Previous Employer

Company Name:

Location:

Phone:

Dates Employeed:

From:

To:

Supervisor

Job Title:

Job Duties:

Reason for Leaving

Other Experience

List other skills that may be valuable to this position.

References

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Relationship:

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Relationship:

Name:

Address:

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Relationship:

By checking the box marked "I agree", I hereby certify the information on this application is true and accurate to the best of my knowledge. * I agree

Employment

Page 1 - Personal Information

Page 2 - Education

Page 3 - Experience