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Employment Application
Applicant's Full Name
Home Address
City
State
Zip Code
Number of years at this address:
Daytime Phone:
Evening Phone:
Mobile Phone:
Emergency Contact
Contact Name
Relationship to you:
Address
City
State
Zip Code
Daytime Phone:
Evening Phone:
Job Position Applied For:
Full or Part Time?
Are you at least 18 years old?
Yes
No
Do you have a valid driver's license?
Yes
No
Are you willing to work any shift, including nights and weekends?
Yes
No
If no, please state limitations:
If you are offered employment, when would you be available to begin work?
If hired, are you able to submit proof that you are legally eligible for employment in the United States?
Yes
No
Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
Yes
No
What reasonable accommodation, if any, would you request?
Have you ever been convicted of a felony or misdemanor?
Yes
No
Yes, I was convited of
on (date)
in (city)
(state)
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT, UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
Applicant Skills
List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and check the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
Skill:
Years of experience:
Rating:
Select:
1
2
3
4
5
Skill:
Years of experience:
Rating:
Select:
1
2
3
4
5
Skill:
Years of experience:
Rating:
Select:
1
2
3
4
5
Applicant Employment History
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.
Employer Name
Supervisor Name
Address
City
State
Zip Code
Job Duties:
Reason For Leaving:
Dates of Employment (Month/Year):
Employer Name
Supervisor Name
Address
City
State
Zip Code
Job Duties:
Reason For Leaving:
Dates of Employment (Month/Year):
Employer Name
Supervisor Name
Address
City
State
Zip Code
Job Duties:
Reason For Leaving:
Dates of Employment (Month/Year):
Applicant's Education and Training
HIGH SCHOOL/GED:
Did you graduate?
Yes
No
Name and Address:
Technical or Vocational Training:
College/University Name and Address:
Did you receive a degree?
Yes
No
If yes, degree(s) received:
Please indicate any current professional licenses or certifications that you hold:
Awards, Honors, Special Achievements:
Military Service:
Yes
No
Branch:
Specialized Training:
It is the policy of Mugsy's Grubhouse to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
References
List 3 professional references or non-relatives who would be willing to provide a reference for you.
Name
Address
City
State
Zip Code
Telephone:
Relationship:
Name
Address
City
State
Zip Code
Telephone:
Relationship:
Name
Address
City
State
Zip Code
Telephone:
Relationship:
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with a current employer:
Certification
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 Mugsy’s Grubhouse to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
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 Owner(s), 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 Mugsy’s Grubhouse, except in a specific written contract of employment signed on behalf of the organization by its Owner(s), has the power to alter or vary the voluntary nature of the employment relationship.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
* Clicking above certifies that all information in your application is true and accurate.
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