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Marietta Diner

Employment Application

* Denotes Required Field


Applicant Information

*M.I.

*Date:

*Street Address:

Apartment/Unit #

*City:

*State:

*Zip:

*Email:

*Date Available:

*Desired Salary:

*Position Applied for:

*Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

*Have you ever worked for this company?

If so, when?

*Have you ever been convicted of a felony?

If yes, explain?

Education

Highschool

Address

College

Address

Other

Address

References

Please list three professional references.

Ref #1

Full Name:

Relationship:

Company:

Phone #

Ref #2

Full Name:

Relationship:

Company:

Phone #

Ref #3

Full Name:

Relationship:

Company:

Phone #

Previous Employment

Prev Employment #1

Company:

Phone #

Address:

Supervisor:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Prev Employment #2

Company:

Phone #

Address:

Supervisor:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Prev Employment #3

Company:

Phone #

Address:

Supervisor:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

*Signature: