Personal Information

* First Name:		* Middle Name:	* Last Name:
* Present Address:	* Apt No.	* City:	* State: AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	* Zip:
* Are you 18 years or older?: Yes No		* Are you 21 years or older?: Yes No		* Email Address:
* Best number to reach you:		* What type of phone is this? Home   Work   Cell

Desired Employment

* Position: -- Select -- Host/Hostess Server Kitchen Staff Chef Management Other	* Restaurant Location Downtown Kansas City Pierponts Leawood Independence Zona Rosa Hollywood Room HH Bar & Grill Shawnee Mission Any
Date available to begin employment:	Income desired :
Are you employed now? Yes No	If so, may we contact your employer? Yes No
Have you ever applied to this company before? Yes No   Where?     When?
Have you ever worked for this company before? Yes No   Where?   When?
Employment Preference: Full-Time  Part-Time  Temporary  Other  No Preference
Days Available: Sunday   Monday   Tuesday  Wednesday  Thursday  Friday  Saturday
Are you willing to work overtime? Yes   No
How did you hear about this position? -- Select -- Our Website Billboard/Sign Co-worker Friend Classifieds Other

Education

High School:
Name:	Major/Courses:
Last year completed: 1   2   3   4	Did you Graduate? Yes   No
Degree/Certificate:
College/Technical School:
Name:	Major/Courses:
Last year completed: 1   2   3   4	Did you Graduate? Yes   No
Degree/Certificate:
Other (Specify) :
Name:	Major/Courses:
Last year completed: 1   2   3   4	Did you Graduate?  Yes   No
Degree/Certificate:

Skills and Qualifications

Please list skills, licenses or certificates that are job-related or that you feel would be of value to this job or company :

Record of Employment

1. Current/Most Recent Employer
* Company:		Address:
* City:		* State:  AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip code:
* Telephone:		* Supervisor:
* Dates Employed:  From    To    date format (MM/YY)
* Rate of Pay per -- Select -- Hour Week Month :  * Start    *End
Reason for Leaving:
Your Duties:
May we contact the employer?  Yes   No

2. Next Previous Employer
Company:		Address:
City:		State:  AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip code:
Telephone:		Supervisor's Name and Title:
Dates Employed:  From    To    date format (MM/YY)
Rate of Pay per -- Select -- Hour Week Month :  Start    End
Reason for Leaving:
Your Duties:
May we contact the employer?  Yes   No

3. Next Previous Employer
Company:		Address:
City:		State:  AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip code:
Telephone:		Supervisor's Name and Title:
Dates Employed:  From    To    date format (MM/YY)
Rate of Pay per -- Select -- Hour Week Month :  Start    End
Reason for Leaving:
Your Duties:
May we contact the employer?  Yes   No

4. Next Previous Employer
Company:		Address:
City:		State:  AL AK AZ AR CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip code:
Telephone:		Supervisor's Name and Title:
Dates Employed:  From    To    date format (MM/YY)
Rate of Pay per -- Select -- Hour Week Month :  Start    End
Reason for Leaving:
Your Duties:
May we contact the employer?  Yes   No

Other Information

Have you ever pled guilty, or no contest to, or been convicted of, a misdemeanor or felony? Yes   No   If Yes, please give the date(s) and details:

Have you been arrested for any matters for which you are out on bail or on your own recognizance pending trial? Yes   No   If Yes, please give the date(s) and details:

NOTE: Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic infractions, and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pre-trial or post-trial diversion programs in answering these questions.)

Have you ever been in Military Service? Yes   No   If Yes, please give the date(s) and details:

NOTE: A dishonorable or general discharge is not an absolute bar to employment. Other factors will affect a final decision to hire or not to hire.

Attach Resume - OPTIONAL (.TXT Files Only):

Important! Please Read.

I hereby authorize investigation of all statements contained in this application, including inquiry of any and all of my former employers or references as indicated elsewhere on this application, and hold said former employers and/or references harmless from liability arising therefrom. I affirm that all the information contained in this application is true and correct, and that any misrepresentation, falsification or omission herein shall be sufficient reason for dismissal from, or refusal for employment. If employed, I understand that the company reserves the right to modify or terminate my employment at any time, with or without cause, and without prior notice. I further understand that the duration, hours, nature, compensation and benefits of my employment may be changed or modified from time to time without limitation or condition. I understand that no representative of the company has any authority to make any assertions to the contrary. I hereby agree to abide by all policies and rules of this company which govern dress, hair, grooming and attitude.

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