Employment Application

Personal Information

*Items in red are required

First Name

Last Name

Phone

Age

Address

Address 2

City

State

Zip

Worked here before?

Desired Employment

Location

Bellevue

Miracle Hills

Downtown

Aksarben

Millard

Plattsmouth

Elkhorn

Position

Bartender

Server

Rover

Kitchen

Management

Type

Full

Part

Seasonal

Available

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Sundays

Desired Pay

Available to Start

Referred By

Employment History

Employer 1

Employer

Address

Phone

Title

Duties

Pay

Reason for leaving

Start Date

End Date

May we contact?

Employer 2

Employer

Address

Phone

Title

Duties

Pay

Reason for leaving

Start Date

End Date

May we contact?

Employer 3

Employer

Address

Phone

Title

Duties

Pay

Reason for leaving

Start Date

End Date

May we contact?

Education

Education 1

Type

School Name

School Location

Field of Study

Start Date

End Date

Education 2

Type

School Name

School Location

Field of Study

Start Date

End Date

Education 3

Type

School Name

School Location

Field of Study

Start Date

End Date

Additional Areas of Expertise

Please describe relevent skills and experience

List the foreign languages you speak fluently

Physical Record

Do you have any physical disabilities that prevent you from performing the work for which you are applying? If so, describe:

By submitting this form you acknowledge that you have read, and agree, to the following terms:

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.