Employment Opportunities

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12670 Edinboro Rd. • Edinboro, PA 16412
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Applicant Information

First Name:
Middle Initial:
Last Name:
Address:
Apartment/Suite:
City:
State:
Zip Code:
Phone:
Email:
Date Available:
Position Applied For:
ServerBartenderCookDishwasher / Food RunnerHousekeepingProperty Maintenance


Are you a citizen of the United States?
YesNo
If no, are you authorized to work in the U.S.?
YesNo
Have you ever worked for this company?
YesNo
If so, when?
Have you ever been convicted of a felony?
YesNo
If “Yes”, please explain:
How did you hear about us / Who were you referred by?



Education

High School:
Address:
From:
To:

  Did you graduate? YesNo
Degree:
College:
Address:
From:
To:

  Did you graduate? YesNo
Degree:
Other:
Address:
From:
To:

  Did you graduate? YesNo
Degree:



References

Please list three professional references.

Full Name:
Relationship:
Phone Number:
Company:
Address:


Full Name:
Relationship:
Phone Number:
Company:
Address:


Full Name:
Relationship:
Phone Number:
Company:
Address:



Previous Employment

Company Name:
Phone:
Address:
Job Title:
Supervisor:
Reason for Leaving:
Responsibilities:
Starting Salary $:
Ending Salary $:
From:
To:
May we contact your previous supervisor for a reference?
YesNo


Company Name:
Phone:
Address:
Job Title:
Supervisor:
Reason for Leaving:
Responsibilities:
Starting Salary $:
Ending Salary $:
From:
To:
May we contact your previous supervisor for a reference?
YesNo


Company Name:
Phone:
Address:
Job Title:
Supervisor:
Reason for Leaving:
Responsibilities:
Starting Salary $:
Ending Salary $:
From:
To:
May we contact your previous supervisor for a reference?
YesNo



Availability

Total Hours per Week:
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY



DISCLAIMER

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.