Date:
First Name:
Last Name:
Social security number:
Address Street:
City:
Zip Code:
(5 digits)
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Daytime Phone:
Evening Phone:
Referred by:
Email:
Are you 18 years or older?:
Can you, if hired, provide documentation verifying identity and authorization to work in the United States, in accordance with the Immigration Reform and Control Act of 1986?:
Have you ever been convicted of a criminal offense other than a minor traffic violation within the last five years?:
If yes, please describe:
(Note: A conviction record does not automatically disqualify you from employment consideration):
EMPLOYMENT DESIRED:
Which DESTIHL location are you applying for?:
Position you are applying for?:
Date Available:
Salary desired per hour:
Hours desired per week?:
Are you currently employed?:
If yes, may we contact your current employer?:
Have you ever applied or worked at a DESTIHL Restaurant & Brew Works before?:
If yes, when and where?:
EDUCATION:
High school name:
High school location:
Years attended high school:
Did you graduate high school?:
College, Trade, Business or Correspondence school name:
College, Trade, Business or Correspondence school location:
Years attended:
Did you graduate?:
EMPLOYMENT HISTORY:
(List below your last two employers, starting with most recent first.):
Business name 1:
Business address 1:
Dates employed (Month and Year) 1:
Name of supervisor 1:
Salary 1:
Position 1:
Reason for leaving? 1:
Business name 2:
Business address 2:
Dates employed (Month and Year) 2:
Name of supervisor 2:
Salary 2:
Position 2:
Reason for leaving? 2:
Have you ever been fired from a job?:
If yes, please describe:
AVAILABILITY:
What shifts / hours are you available to work?:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Please list any additional schedule requirements or requests if applicable:
REFERENCES:
Please list two references not related to you, whom you have known at least one year.:
Reference name 1:
Reference phone number 1:
Business 1:
Year(s) known 1:
Reference Name 2:
Reference phone number 2:
Business 2:
Year(s) known 2:
I affirm that all information in this application is true and complete. Any misrepresentation, false statement, or omission of facts called for shall be grounds for refusal of employment or if hired, dismissal from employment.
I authorize investigation of all statements contained herein and employers listed to give you an and all information they may have regarding my employment, and any other pertinent information they may have.
I release all parties from all liability fro any damage that may result from furnishing said information to you. I understand that any violation of company rules, policies, or standards, and/or procedures shall be grounds for dismissal. I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at any time at the option of DESTIHL, LLC or myself.
By electronically signing your name, you hereby agree to the above terms.
Applicant Signature: