Are you 18 years of age or older?
Yes
No
If not, state your age:
Are you legally eligible for employment?
Yes
No
(Proof of Citizenship or Immigration Status will be required upon employment)
Have you ever been employed by BrickHouse?
Yes
No
Dates:
Where?
Reason for leaving:
Job applying for:
Years of related experience:
Rate of pay expected: $
Date Available:
What hours are you available for
work?
What days are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Have you ever been convicted of a crime?
Yes
No
If yes, when?
Nature of Crime?
Do you have any physical limitations which
would adversely affect performance
of the job for which you are applying?
Yes
No
If yes, please explain:
Educational Background
Name/Address/City/State
Graduate?
Employment History
Present or last employer:
Address:
Phone:
Job title or position:
Starting Date:
Leaving
Date:
Starting: $
Ending: $
Name of person for whom you worked:
Reason for leaving:
Present or last employer:
Address:
Phone:
Job title or position:
Starting Date:
Leaving
Date:
Starting: $
Ending: $
Name of person for whom you worked:
Reason for leaving:
May we contact your present or former
employer?
Yes
No
If no, which one?
Please indicate your availability
by checking the shifts below that you can work:
How much money do you need each week?
How many hours per week do you want to
work?
Do you prefer nights or days?
Can you work weekends?
Yes
No
Can you work holidays?
Yes
No
Can you be called upon to work extra
shifts if necessary?
Yes
No
What other companies have accepted your
application recently?
Do you have any interviews pending at any
of these companies?
Yes
No
If yes, when?
What is your long-term goal?
What is your one-year goal?
How many months do you think you can stay
at this job, assuming things go reasonably well?
Do you have an up-coming obligation or
commitment for which you would
need to take a leave of absence?
Yes
No
If yes, please explain:
How did you get along with your former
supervisors?
Have you ever been treated unfairly at
work?
Yes
No
If yes, how?
Where are you currently working, or,
if you are unemployed, where was the last place you worked?
Can your employer be called for a
reference?
Yes
No
What would you tell your previous
supervisors to help him/her to improve business?
Did you get along with your fellow
employees?
Have you been singled out for any awards,
honors, disciplinary actions at your former or current job?
Have you been fired from any of your past
jobs?
Yes
No
If yes, why?
What is one of your abilities that will
make you an especially good employee at BrickHouse?
What is the longest period that you have
worked at a job?
How many days of work have you missed in
the last year?
Why have you not returned to any of your
former employers?
What do you like most about restaurant
work?
What do you like least about restaurant
work?
Do you have reliable transportation?
Will winter driving affect your ability to
get to work?
How long does it take you to drive to
BrickHouse?
What problems do you think we might
encounter working together?
What do you think the concept of
"teamwork" means?
I verify that the information I provided
is voluntary, factual and accurate to the best of my knowledge:
Name:
Date:
