Mossy Creek Job Application

(Pre-employment questionnaire. Mossy Creek Cafe and Catering is an Equal Opportunity Employer)

PERSONAL INFORMATION
First Name:		MI: Last Name:
Present Address:
Permanent Address:
Phone Number:	Social Security Number: e-mail:
Are you 18 years or older?		Yes No
Have you ever been convicted of a felony?		Yes No
Are you prevented from lawfully becoming employed in this countrybecause of visa or immigration status? Yes No

EMPLOYMENT DESIRED
Position Desired:	Date You Can Start:
Are you employed now? Yes No	If so, may we inquire of your present employer? Yes No
Have you ever applied to this company before?	Yes No
If so, where and when?
Referred by:

EDUCATION
Education Level	Name and Location of School	Number of Years Attended*	Did you Graduate	Subjects Studied
Grammar School			Yes No
High School			Yes No
College			Yes No
Trade, Business or Correspondence School			Yes No

GENERAL
Subjects of Special Study or Research Work:
Special Skills:
Activities: (Civic, Athletic, Etc.)	Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or notion of origin of its members
U.S. Military or Naval Service:	Rank:
Present Membership in National Guard or Reserves:

FORMER EMPLOYERS (List below the last three employers, starting with the last one first)
Dates (Month and Year)	Name and Address of Employer	Monthly Salary	Position	Reason for Leaving
From:		$
To:
From:		$
To:
From:		$
To:
Which of these jobs did you like best?
What did you like most about this job?

REFERENCES (Give the names of three persons not related to you, whom you have known for at least one year.)
Name	Address	Business	Years Acquainted

In case of emergency, notify:
Name:	Address:	Phone:

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and intepretative guidance promulgated by the EEOC on July 26, 1991 and has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.

"By submitting this form, I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other that it's President, and then only when in writing and signed by the President, has any authority to enter in to any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."