Job Application

CHICKEN SHACK RESTAURANTS

Date*
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*
Place of Birth*
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*
College or University (Use separate sheet if more space is needed)*
Name & Location From To
Date*
EXPERIENCE
May inquiry be made of your present employer regarding your employment record?*
Date Of Employment*
From To Title
Salary $*
*
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.