Applicant Full Name:
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Home Address:
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City/State/ZIP:
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Number of years at this address:
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Daytime phone:
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(###)
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Email Address:
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Social Security Number:
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Date of Birth:
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MM
DD
YYYY
Driver's License (State/Number):
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Contact Name:
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Relationship to you:
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Address:
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City/State/ZIP:
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Daytime phone:
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Applied For:
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Are you willing to work any shift, including nights and weekends?
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If no, please state any limitations:
If you are offered employment, when would you be available to begin work?
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If hired, are you able to submit proof that you are legally eligible for employment in the United States?
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Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
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What reasonable accommodation, if any, would you request?
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List any skills that may be useful for the job you are seeking. Enter the number of years of experience beside each skill.
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Employer Name:
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Supervisor Name:
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Address:
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City/State/ZIP:
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Job Duties:
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Reason for Leaving:
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Dates of Employment (Month/Year):
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Are you currently bound by any agreements with this employer (circle)?
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If yes, describe the nature of the agreement
Employer Name:
Supervisor Name:
Address:
City/State/ZIP:
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
Are you currently bound by any agreements with this employer (circle)?
If yes, describe the nature of the agreement
Please provide any other information that you believe should be considered.
Name:
*
Address:
*
City/State/ZIP:
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Telephone:
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Relationship:
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Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
CERTIFICATION
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I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize The Bullpen Bar and Grill to contact former employers regarding my employment. I authorize my former employers to fully and freely communicate information regarding my previous employment, including attendance. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment.
If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Manager, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of The Bullpen Bar and Grill, except in a specific written contract of employment signed on behalf of the organization by its Manager, has the power to alter or vary the voluntary nature of the employment relationship.
APPLICANT SIGNATURE
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Date
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MM
DD
YYYY
