Personal Information
Last Name
First Name
Social Security No.
Present Address: City / State / Zip Code
Permanent Address: City / State / Zip Code
Phone No.
Secondary Phone No.
Referred By

Employment Desired
Position Desired	- Choose an Option - Waiter/Waitress Host/Hostess Bartender Management Cooking Cashier Busboy Dishwasher
Date You Can Start
Salary Desired
Are You Employed Now?	- Choose an Option - Yes No
If so, may we inquire of your present employer?	- Choose an Option - Yes No
Ever applied to this company before?	- Choose an Option - Yes No
Where?
When?

Education History
Name and Location of High School
Years Attended High School
Did you graduate High School?
Subjects Studied in High School
Name and Location of College
Years Attended College
Did you graduate College?
Subjects Studied in College
Name and Location of Trade, Business, or Correspondence School
Years Attended Trade, Business, or Correspondence School
Did you graduate Trade, Business, or Correspondence School
Subjects Studied in Trade, Business, or Correspondence School

General Information
Subject of Special Study/Research Work
Special Training
Special Skills
U.S. Military or Naval Service
Rank

Former Employers
List below last four employers, starting with last one first. Please also include Date: Month and Year of employment, Salary, Position and Reason for Leaving.

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