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222 Pearl St
La Crosse, WI 54601

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Application for Employment

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(Please answer all questions where possible)

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

NOTICE: Applicant should read the following information carefully before filling out any of the questions on this form. We are an equal opportunity employer and fully subscribe to the principles of equal opportunity. It is our policy to seek and employ the best qualified personnel in all positions without regard to race, color, religion, age, sex, disability, national origin or any other basis made unlawful by either state or federal law. It is our policy to comply with all federal and state employment statuses. Information requested on this application will not be used for any purpose prohibited by law.

Applicant

*First Name

*Middle Name

*Last Name

*Address

Address 2

*City

*State

*ZIP Code

*Phone Number

Email Address

*How long have you lived at the above address?

*Are you 18 years old or older?

*Have you had any name changes this employer should know about in order to verify job or education history?

*Do you have transportation to and from work?

*Are you authorized to work in the U.S.?

*Position applied for

*Date you can start

*Salary Desired

*Are you applying for

Who recommended you for this position

Education: High School

Name and address of school

Grade or Degree Completed

Did you Graduate?

Education: College or University

Name and address of school

Grade or Degree Completed

Did you Graduate?

Education: Others (specify)

Name and address of school

Grade or Degree Completed

Did you Graduate?

Education: Military Schools Attended

Name and address of school

Grade or Degree Completed

Did you Graduate?

Military Service Record

*Are you a War Veteran?

Branch

From

Highest Grade

Work Experience

Please check the kind of work you have done:

Previous Restaurant Experience

(List below your last four employers, starting with most recent one first)

Employer #1

Company Name

Address

Company Business

Your Position

Immediate Supervisor

Title

Phone

Salary

Reason For Leaving

Date Started

Date Left

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Job Duties

Are there any job duties that you would be unable to perform?

Is there anything we could do to accommodate you so you could perform all the required job duties?

*Have you ever applied to this company before?

*Are you now employed?

Telephone Number

In Case of Emergency

*In case of emergency notify (Name, Address, Phone)
Relationship, if any

Resume

If you would like to attach a resume, please do so here.

Accepted file formats are: DOC, DOCX, RTF, PDF, and TXT.

Resume

Acknowledgment of Notice

Please read and confirm below:

I authorize investigation of all statements contained in this application.
I understand that misrepresentation or omission of facts called for is cause for dismissal and that my employment is substantially dependent on truthful answers to the forgoing inquiries.
I have read these statements and answers to these inquiries.

*I have read and agree to the above:

Agreed

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Call Us

Hours

Visit Us

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Application for Employment

Applicant

Education: High School

Education: College or University

Education: Others (specify)

Education: Military Schools Attended

Military Service Record

Work Experience

Previous Restaurant Experience

Employer #1

Employer #TOK_PREV

Job Duties

In Case of Emergency

Resume

Acknowledgment of Notice