Career Personal Information Name* First Middle Last Home Phone*Work PhoneCell PhoneEmail Address* Present Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Permanent Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are You 18 Years or Older?*YesNoHow Did You Hear About Our Organization? Walk In Newspaper School Referred Who Were You Referred By?Employment Desired Position*Salary Requirements ($)*Date You Can Start*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have You Ever Applied for This Company Before?*YesNoHours Available to WorkFull-TimePart-TimeEitherDays Available to Work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Education School/College*City*State*Degree/Certificate/Diploma*Course of Study*Years Completed*Graduated*YesNoLanguage(s) Known* English Spanish Other Subjects of Special Study or Research WorkSpecial SkillsActivities (Civic, Atheltic, etc...)U.S. Military or Present Membership in Naval Service Rank, National Guard, or ReservesFormer Employers Have you worked for Palenque Grill before?YesNoMost Recent Employer Employer*Position Held*From (mm/yyyy)*To (mm/yyyy)*Pay Upon Leaving*Reason for Leaving*Former Employer 1 EmployerPosition HeldFrom (mm/yyyy)To (mm/yyyy)Pay Upon LeavingReason for LeavingFormer Employer 2 EmployerPosition HeldFrom (mm/yyyy)To (mm/yyyy)Pay Upon LeavingReason for LeavingWhich of These Jobs Did You Like Best?What Did You Like Most About this Job?References Reference 1 Name*Address*Telephone*Business*Years Known*Reference 2 Name*Address*Telephone*Business*Years Known*Reference 3 Name*Address*Telephone*Business*Years Known*Agreement 1. I hereby verify that information provided is true, complete and accurate. I agree that the Company may investigate all statement made on this application form and that any misrepresentation or omission is cause for dismissal. 2. I understand that Company may review references, credit files, and criminal records as part of the employment process. 3. I understand that no employee, manager or other agent of the Company has the authority to enter into any agreement for employment for any specified period of time unless such an agreement is in writing and signed by President of Casa Palenque, Inc. I further understand that in the absence such an agreement employment can be terminated at the sole discretion of the Company employer any time. 4. I understand that this application will remain active for 30 days.
