Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Available *

MM

DD

YYYY

Position(s) Applied For

Floor Manager

Sous Chef

Host

Server

Bartender

Busser

Food Runner

Dish

Prep

Line

Full Time or Part Time?

Full Time

Part Time

Days Available

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the United States?

Yes

No

Have you ever been convicted of a felony?

Yes

No

Did you graduate?

Yes

No

Currently Enrolled

Did you graduate?

Yes

No

Currently Enrolled

Did you graduate?

Yes

No

Currently Enrolled

Reference #1

First Name

Last Name

Reference # 2

First Name

Last Name

Reference #3

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

First Name

Last Name

May we contact your supervisor for a reference?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

First Name

Last Name

May we contact your supervisor for a reference?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

First Name

Last Name

May we contact your supervisor for a reference?

Yes

No

Disclaimer *

I certify that my answers are true and complete to the best of my knowledge.   I understand that any misrepresentation, falsification or omission of this application or interview shall be sufficient reason for refusal or dismissal of my employment. I hereby authorize investigation of all matters contained in this application and agree that if the results of such investigation are not satisfactory, any offer of employment made by Rosie O’Grady’s, Inc. may be terminated immediately. I agree to conform and adhere to the policies & procedures of Rosie O’Grady’s, Inc. and it subsidiary operations.   Furthermore, I understand and agree that this application and any other materials I receive are not intended to be, nor shall be construed  to be a contract of employment, and that my employment and compensation may terminate, with or without cause, and with or without notice, at any time, at the option of either Rosie O’Grady’s, Inc. or myself.   Any losses or expenses incurred by the Company, its clientele or any other third parties as a result of my unauthorized actions shall be immediately reimbursed on terms satisfactory and accepted by the Company. To the extent permitted by law, I agree and hereby authorize the Company to reduce my wages for any sums owing by me hereunder.   I fully understand the Company performs and requires random drug testing as well as testing for cause.   I UNDERSTAND AND AGREE BY ELECTRONICALLY SIGNING BELOW

First Name

Last Name