Jim's Steakout

High School Name:

Graduated?
No
Yes

Location:

Courses Studied:

College Name:

Graduated?
No
Yes

Location:

Courses Studied:

Trade/Other School:

Graduated?
No
Yes

Location:

Courses Studied:

Dates Worked:

Supervisor's Name:

Position Held:

Company and Address

Reason for Leaving:

Dates Worked:

Supervisor's Name:

Position Held:

Company and Address

Reason for Leaving:

Dates Worked:

Supervisor's Name:

Position Held:

Company and Address

Reason for Leaving:

List three persons not related to you whom you have known at least one year.

1) Name:

Address:

Occupation:

Phone:

2) Name:

Address:

Occupation:

Phone:

3) Name:

Address:

Occupation:

Phone:

Applicant's AgreementPlease read the following statement carefully.

I hereby certify that the facts contained in this employment application are true and complete to the best of my knowledge. I understand that if I am employed, falsified statements or omissions shall be considered sufficient cause for dismissal. I hereby authorize inquiries to my former employers, whose names I gave, to furnish information regarding my work and personal character to this prospective employer.

By checking this box I am stating that I have read
and understood the above agreement.