Employment Applicant InformationPlease enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *AddressAddress Line 1CityState*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you under 18 years of age? *YesNo(If under 18 years of age, a work permit is required.)Are you eligible for employment in the United States? *YesNo(Proof of U.S. citizenship or immigration status will be required upon employment)Have you ever been convicted of, or pled guilty to a felony or a misdemeanor? *YesNoIf yes, please list all crimes that you have been convicted of or pled guilty to and include the date of the offense. A criminal record will not necessarily disqualify an applicant for employment.Have you ever been employed by the company? *YesNoIf yes, identify the dates of employmentEducationHigh School Name *High School Location *Course of StudyDid you graduate? *YesNoDegreeDiplomaGEDCollege NameCollege LocationCourse of StudyDid you graduate?YesNoOther Education NameOther Education LocationCourse of Study (copy) (copy)Did you graduate?YesNoReferencesPlease list three references who are not relatives.Name and OccupationAddressPhoneNumbersName and OccupationAddressPhoneNumbersName and OccupationAddressPhoneNumbersEmployment HistoryEmployer NameEmployer AddressSupervisor NamePhoneFrom (month/year)To (month/year)Position HeldLast SalaryReason for LeavingResponsibilities Employer NameEmployer Address Supervisor NamePhoneFrom (month/year)To (month/year)Position HeldLast SalaryReason for LeavingResponsibilitiesAre you presently employed? *YesNoMay we contact your present/previous employer(s)? *YesNoAre you interested in: *Full-timePart-timeTemporaryHow many hours per week?If temporary, please explain.Are there any hours during the day when you would not be available for work? *Yes NoIf yes, please specify.Are you willing to work on weekends? *Yes NoWhat hours do you prefer to work? *DayEveningNightHave you ever been discharged or forced to resign from any place of employment? *Yes NoIf yes, please specify.What do you consider an acceptable wage/salary for this position?I have read and fully understand the contents of this Certification and Acknowledgment.Hometown Breakfast, Bar and Grill maintains a policy of non-discrimination for all employees and applicants in every facet of the company’s operations. In compliance with federal and state laws, Hometown Breakfast, Bar and Grill provides equal opportunities at all levels of employment without regard to race, sex, age, color, religion, national origin, veteran status, creed, marital status, disability or sexual orientation. I certify that the information contained in this application is correct to the best of my knowledge. I further understand that falsification, misrepresentation or omission of facts is sufficient cause for rejection of this application or discharge if I am later employed. I understand that all statements made here are subject to verification by Hometown Breakfast, Bar and Grill. I authorize and consent to any person or organization referenced in this application to furnish Hometown Breakfast, Bar and Grill with any and all information concerning my previous employment, education, or any other information pertaining to me upon its request. I release from all liability or responsibility all persons or organizations requesting or supplying such information. For purposes of verification, a photocopy of this authorization shall be considered an original and valid. If employed, I understand that I will be an employee “at will” and either Hometown Breakfast, Bar and Grill or I may terminate the employment relationship at any time with or without notice. I acknowledge that any offer of employment, or my acceptance of such, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of Hometown Breakfast, Bar and Grill or myself. I understand that this application and any other documents which I may receive are not contracts of employment. I agree to comply with Hometown Breakfast, Bar and Grill’s rules, regulations and policies and acknowledge that these rules, regulations and policies may be changed, interpreted, withdrawn, or supplemented any time and without prior notice to me.Submit