Job Application

CHICKEN SHACK RESTAURANTS

“AN EQUAL OPPORTUNITY EMPLOYER”

APPLICATION FOR EMPLOYMENT

Date*
MM slash DD slash YYYY
Title of Position Applying For*
Name (Mr., Mrs., Miss)*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Address if at Present Address Less Than One (1) year:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
MM slash DD slash YYYY
Place of Birth*
MM slash DD slash YYYY
Would you accept employment:*
Full-time Part-time Temp.
When will you be available for employment*
Telephone Number*
EDUCATION
High School*
First Last
Highest Grade Completed*
Graduated or GED*
Year*
MM slash DD slash YYYY
College or University (Use separate sheet if more space is needed)*
Name & Location From To
Date*
MM slash DD slash YYYY
EXPERIENCE
May inquiry be made of your present employer regarding your employment record?*
Date Of Employment*
From To Title
Salary $*
$ Present*
Hours Per Week*
No. Persons Supervised*
Name and Address of Employer*
Type of Business*
Your Supervisor*
Title*
Telephone Number #*
Reason for Leaving*
Brief Description of Work*
REFERENCES
Name, Address, Occupation, & Phone Number*
Name, Address, Occupation, & Phone Number
Do you have any physical or other handicap(s)?*
Have you ever been fired or forced to resign from any job?*
Have you ever served on active duty in the U.S. Military Services?*
NOTE: A false answer to any question in the application could be grounds for disqualifying you for employment.

I certify that the answers to all questions in this application are true and correct to the best of my knowledge.

Job Application

CHICKEN SHACK RESTAURANTS

“AN EQUAL OPPORTUNITY EMPLOYER”

APPLICATION FOR EMPLOYMENT

EDUCATION

EXPERIENCE

REFERENCES

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