Burger Bach :: Midlothian Application

Date of application: *
First Name: *
Last Name: *
Middle Initial:
Email: *
Address: *
City: *
State: *
Zip Code: *
Daytime Phone: *
Nighttime Phone:
Are you legally able to work in the United States? (Proof of identity and legal authority to work in the United States is a condition of employment) *	Yes No
What position are you applying for? *
At which location would you like to work? *
At which location would you like to work? *
If Other, explain here:
Desired starting wage:
What employment are you seeking?
Have you ever been employed at Burger Bach? *	Yes No
If Yes, what location?
What was the date of your employment at that location?
Who Referred you to Burger Bach restaurant?
Date available for employment: *
Have you ever been convicted of a felony which has not been annulled or sealed by a court? (convictions will not necessarily exclude you from employment, but date and type of conviction may be considered for job placement.) *	Yes No
If YES, please explain:
WORK SCHEDULE AVAILABILITY What shifts are you available to work? We have shifts from 7:00 AM to 12:00 AM DAY OF THE WEEK: *	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
TIME OF DAY (Ex: 7am to 6pm) (Enter specific day if the time you list applies to only that day) *
Are you willing to work a split shift? *	Yes No
Are you willing to come in early or stay late in case of emergency? *	Yes No
Are you willing to work holidays/weekends (Friday-Sunday)? *	Yes No
How many hours do you expect to work? *
EDUCATION High School:
Address:
Courses majored in:
Last year completed:
Diploma / Degree?	Yes No
College:
Address:
Courses majored in:
Last year completed:
Diploma / Degree?	Yes No
Other education:
Address:
Courses majored in:
I affirm that all information in this appplication is true and complete. *	Yes No
Last year completed:
Diploma / Degree?	Yes No
PERSONAL REFERENCE 1 Ref. 1 Name:
Ref. 1 Address:
Ref. 1 Phone:
Ref. 1 Relationship:
Ref. 1 Years Acquainted:
PERSONAL REFERENCE 2 Ref. 2 Name:
Ref. 2 Address:
Ref. 2 Phone:
Ref. 2 Relationship:
Ref. 2 Years Acquainted:
PERSONAL REFERENCE 3 Ref. 3 Name:
Ref. 3 Address:
Ref. 3 Phone:
Ref. 3 Relationship:
Ref. 3 Years Acquainted:
WORK EXPERIENCE EMPLOYER 1:
Emp. 1 phone
Emp. 1 Address:
Emp. 1 City, State, Zip Code:
Emp. 1 Supervisor:
Emp. 1 Title:
Emp. 1 Your Position:
Emp. 1 Start Date:
Emp. 1 Ending Date:
Emp. 1 Starting Wage:
Emp. 1 Ending Wage:
Emp. 1 Reason for leaving:
EMPLOYER 2:
Emp. 2 Phone:
Emp. 2 Address:
Emp. 2 City, State, Zip Code:
Emp. 2 Supervisor:
Emp. 2 Title:
Emp. 2 Your Position:
Emp. 2 Start Date:
Emp. 2 Ending Date:
Emp. 2 Starting Wage:
Emp. 2 Ending Wage:
Emp. 2 Reason for leaving:
EMPLOYER 3:
Emp. 3 Phone:
Emp. 3 Address:
Emp. 3 City, State, Zip Code:
Emp. 3 Supervisor:
Emp. 3 Title:
Emp. 3 Your Position:
Emp. 3 Start Date:
Emp. 3 Ending Date:
Emp. 3 Starting Wage:
Emp. 3 Ending Wage:
Emp. 3 Reason for leaving:
I AFFIRM THAT ALL INFORMATION IN THIS APPLICATION IS TRUE AND COMPLETE.**	Yes No
Applicant Signature: *
Date: *
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