PERSONAL INFORMATION First Name Middle Name Last Name Address City State Zip Phone Check if Mobile Email Are you legally eligible to work in the US? -Select One- Yes No Referred by Name of employee you are related to, if any. Are you Over 19?Required if serving alcohol in Nebraska. -Select One- Yes No Have you been convicted of a felony? -Select One- Yes No POSITION Position you are applying for. Date you can start. Hourly Wage Expected Are you currently employed? -Select One- Yes No May we contact your present employer? -Select One- Yes No Days/Time you are available to work. EDUCATION Enter schools attended, starting with high school. High School School Name City, State Year Graduated or will Graduate College / Other School Name City, State Year Graduated or will Graduate Major College / Other School Name City, State Year Graduated or will Graduate Major Organizations, Clubs, Groups, Teams, etc. you are a member of. What skills or additional training do you have that are related to the job for which you are applying? REFERENCES Provide at least two persons not related to you who have known you for at least one year. Reference 1 Name Phone Relationship Years Acquainted Reference 2 Name Phone Relationship Years Acquainted Reference 3 Name Phone Relationship Years Acquainted EMPLOYMENT HISTORY Please enter your last five employers with the most recent one first. Employer 1 Company Name Job Position Time Employed month / year you started and ended. Reason for Leaving Work Phone Ending Hourly Pay Address City State Zip Employer 2 Company Name Job Position Time Employed month / year you started and ended. Reason for Leaving Work Phone Ending Hourly Pay Address City State Zip Employer 3 Company Name Job Position Time Employed month / year you started and ended. Reason for Leaving Work Phone Ending Hourly Pay Address City State Zip Employer 4 Company Name Job Position Time Employed month / year you started and ended. Reason for Leaving Work Phone Ending Hourly Pay Address City State Zip Employer 5 Company Name Job Position Time Employed month / year you started and ended. Reason for Leaving Work Phone Ending Hourly Pay Address City State Zip OTHER INFORMATIONAnything else you want us to know about you. SIGNATURE DISCLAIMER I certify that the information provided in this application for employment is true, correct, and complete. If employed, any misstatements or omission of facts on this document may result in my dismissal. I understand that acceptance of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I authorize you to conduct an investigation of my credit and personal history. If a report is obtained, you must provide, at my request, the name of the agency so I may review the nature and substance of the information in the report.
