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Personal Information

Last Name Mid. Initial First Name Date
/ /
Social Security Number Phone Number Are you 18 years or older?
- - ( ) -
Yes No
Present Address      
Street City State Zip
Permanent Address
Street City State Zip
E-Mail Address
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Yes No
U.S. Military or Naval Service Rank Present Membership in National Guard or Reserves
Yes No

 

Employment Desired

Position Date you can start Salary desired
/ / $ . / hour
Are you employed now? If so, may we inquire of your present employer?
Yes No
Yes No
Have you ever applied to this company before?   Yes         No   
Where?   
When?    / /
Referred by:   
Which location are you applying for?   Gilly's Pub 44 Original       Gilly's Pub 44 Riverfront

 

Education

 

Name and Location of School

*No. of years attended

*Did you graduate?

Subjects Studied

High School
Yes No
College
Yes No
Trade,
Business or
Correspondence school
Yes No

 

Former Employees (List last three employers, starting with the last one first)

Date (month/year)

Name and Address of Employer

Salary
/ $ .
/ $ .
/ $ .
Position Reason for Leaving
 
 
 

 

Which of these jobs did you like the best?
What did you like most about this job?

 

References(Give the names of three persons not related to you, whom you have known at least one year)

Name

Address

Business

Years Acquainted

In case of Emergency Notify:
Name Address Phone Number
( ) -

 

PLEASE READ THE FOLLOWING CAREFULLY.
By checking this, "I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration for my employment, I agree to confirm to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it's president, and then only in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."
Yes No

 

Gilly's Pub 44 is an Equal Opportunity Employer.

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

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