Job Application – Merry-Ann's Diner

Position Applying for:

Today's Date

Name *

First

Last

Email *

Phone Number

Address

City

Zip Code

Drivers License Number & State

Are you able to perform the essential functions of the position with or without accommodations

If necessary for the job are you older than:

I am legally eligible for employment in the U.S.?

Are you seeking Full-time or Part-time work?

How soon are you available for work?

Immediately
In a week
In two weeks
In a month

What shifts are you available to work?

Employment History 1 - Include: Position Title/Employer Name/Address/Start Date/End Date/Position Description/Reason for Leaving/Pay/Supervison/Telephone Number

Employment History 2 - Include: Position Title/Employer Name/Address/Start Date/End Date/Position Description/Reason for Leaving/Pay/Supervison/Telephone Number

Employment History 3 - Include: Position Title/Employer Name/Address/Start Date/End Date/Position Description/Reason for Leaving/Pay/Supervison/Telephone Number

Employment History 4 - Include: Position Title/Employer Name/Address/Start Date/End Date/Position Description/Reason for Leaving/Pay/Supervison/Telephone Number

Education

Are you a Veteran?

Other qualifications, special skills, honors to be considered.

Reference 1

List two personal References who are not relatives or former supervisors

Reference 2

List two personal References who are not relatives or former supervisors

Information to the Applicant *

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization for work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to this information shown above.

Date

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Developed at the employer based on Illinois Department of Labor & Workforce Development, Employment Security Division.