Dilly D Burgers - Employment Application

Position Applying For: Select a position Cashier Cook Server Manager Delivery Driver

Personal Data

Full Name: Address: City: State: Zip Code: Home Phone: Business Phone: Cell Phone: Email: Upload Résumé (PDF/DOC, Max 2MB): Date You Can Start Work: Date of Birth: High School Diploma or GED: Yes No

Position Information

Willing to Work (Hours/Shifts): Authorized to work in U.S.? Yes No Felony Conviction? No Yes If Yes, Explain: Informed of Essential Functions? Yes No Can Perform Essential Functions with/without Accommodation? Yes No

Qualifications

Education/Training:

Special Skills

References

Reference 1 (Name, Address, Phone, Relationship): Reference 2 (Name, Address, Phone, Relationship): Reference 3 (Name, Address, Phone, Relationship):

Work History

Job #1 Details: Job #2 Details: Job #3 Details: Job #4 Details:

Applicant Agreement

I certify that the information provided is true and complete. I understand that false information may be grounds for dismissal. I authorize verification of any information listed above. I understand that employment is at-will and may be terminated at any time.

Signature (Type Full Name): Date: