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Employment Form

APPLICATION FOR EMPLOYMENT
Name*
First Middle Last
Address (Street, City, State, Zip Code)*
How Long?
Home Telephone Number*
GENERAL INFORMATION
Are You 18 years Of Age Or Older?*
- Yes
- No
If not, state date of birth
If under age 18, how many hours per week are you employed elsewhere?
Have you had any name changes this employer should know about in order to verify job or education history?*
- Yes
- No
Previous Name
Do you have transportation to and from work?*
- Yes
- No
Only U.S. Citizens Or Aliens Who Have A Legal Right To Work In The U.S. Are Elgible For Employment. Can You, Upon Employment, Provide Genuine Documentation Establishing Your Identity And Elgibility To Be Legally Employed In The United States?*
- Yes
- No
Hidden
Position Applied For*
Date Available For Work?
MM slash DD slash YYYY
Hidden
Wage Desired
Please Check Schedule Availability*
- Full Time
- Part Time
- Temporary
- Days Only
- Nights Only
- Days/Nights
Who recommended you for this position?
Note: Work Schedules Are Based Upon The Needs Of The Business And May Be Subject To Change On A Weekly Basis.
EMPLOYMENT HISTORY
Begin With Your Most Recent Employment (1) And Continue With Past Employment
Employment #1
Company Name
Address
Street Address City State ZIP Code
Phone Number
Type of Business
Your Position
Name & Title of Supervisor
Employed From
(mm/yyyy)
Employed To
(mm/yyyy)
Starting Wage
Ending Wage
Reason for Leaving
Employment #2
Company Name
Address
Street Address City State ZIP Code
Phone Number
Type of Business
You Position
Name & Title of Supervisor
Employed From
(mm/yyyy)
Employed To
(mm/yyyy)
Starting Wage
Ending Wage
Reason for Leaving
Employment #3
Company Name
Address
Street Address City State ZIP Code
Phone Number
Type of Business
Your Position
Name & Title of Supervisor
Employed From
(mm/yyyy)
Employed To
(mm/yyyy)
Starting Wage
Ending Wage
Reason for Leaving
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?
- Yes
- No
If yes, where?
When?
Are you now employed?
- Yes
- No
Phone
Emergency Contact
In case of emergency, notify:
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Relationship*
EDUCATION

Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Type of School	Name and Address Of School	Highest Grade Or Degree Completed	Graduate?

Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools

Military
War Veteran?
- Yes
- No
Military Training or Experience
Please include Branch and start/end service dates.
Please check the kind of work you have done:
- Bartender
- Bookkeeper
- Bus Person
- Carver
- Chef
- Cook
- Cook Helper
- Counter
- Dietician
- Dishwasher
- Food Prep Technician
- Fountain
- Host or Hostess
- Kitchen Helper
- Manager
- Pantry
- Pastry Cook
- Porter
- Pot Washer
- Salad
- Sandwiches
- Stenographer
- Typist
- Vegetable Cook
- Wait Staff
- Wait Staff - Arm Service
- Wait Staff - Tray Service
NOTIFICATION AND AGREEMENT
1. I authorize investigation of all statement contained in this application.

2. 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 foregoing inquiries.
I have read these statement and answers to these inquiries.*
- Yes
Signature (Type your initials)*
DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
Today's Date*
MM slash DD slash YYYY
Resume
Max. file size: 50 MB.
If you have an electronic version (Word, PDF, etc.) of your resume, you may attach it here.
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Open Positions

Wait Staff
Cooks
Bartendar
Cashiers

Contact Info

(715) 442-5500
210 3rd Street, WI-35,
Pepin, WI 54759

Hours

Open Daily 11:00 am to 8:00 pm. except closed Thursdays and if the temperature is below 55 degrees call because after all we are an all outdoor bar and grille.
We will be closed on Thursdays until the end of the season.

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