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Carytown Menu
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Durham
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Charlottesville
Carytown
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Events
Locations
Date of application:
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First Name:
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Last Name:
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Middle Initial:
Email:
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Address:
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City:
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State:
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Zip Code:
*
Daytime Phone:
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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?
*
----
Server
Host
Bartender
Line Cook
Prep Cook
Dishwasher/Utility
Other
At which location would you like to work?
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----
Short Pump
Carytown
Charlottesville
Midlothian
Durham
At which location would you like to work?
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Short Pump
Carytown
Charlottesville
Midlothian
Durham
If Other, explain here:
Desired starting wage:
What employment are you seeking?
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Full Time
Part Time
Have you ever been employed at Burger Bach?
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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.)
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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:
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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)
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Are you willing to work a split shift?
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Yes
No
Are you willing to come in early or stay late in case of emergency?
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Yes
No
Are you willing to work holidays/weekends (Friday-Sunday)?
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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:
*
Please type the letters and numbers shown in the image.