Application Form - Casa Grande - Mexican Restaurant of Hohenwald, Tn

Applicant Information

Full Name:

First Name

Mid Name

Last Name

Date

Address:

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone

Date Available

Social Security No

Desired Salary

Position Applied for

WORK SCHEDULE AVAILABILITY

What shifts/hours are you available to work? We have shifts from 11:00 AM to 10:00 pm

(Please list hours in each AM/PM box).

Are you willing to work a split shift?YesNo

Are you willing to stay late in an emergency?YesNo

Are you willing to work holidays / weekends?YesNo

How many hours per week do you expect to work?

Shift

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Education

High School

Address

From

Did you graduate?YesNo

Diploma

College

Address

From

Did you graduate?YesNo

Diploma

Other

Address

From

Did you graduate?YesNo

Diploma

References

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Previous Employment

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?YesNo

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?YesNo

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?YesNo

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Date