Blue Agave Mexican Restaurant

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Name

Address

City, State, Zip

Phone #

Date Available
APPLICANT INFORMATION
Date

Social Security No.

Position Applied for

Date of Birth

Email Address
Are you a citizen of the United States?

Have you ever worked for this company?

Have you ever been convicted of a felony?
If no, are you authorized to work in the U.S.?

If so, when?

If yes, explain
Do you have ANY objection working weekends?
AM


PM
 Monday        Tuesday        Wednesday      Thursday           Friday           Saturday          Sunday
   EDUCATION (LIST SCHOOL NAME, LOCATION, YEARS COMPLETED, AND ANY DEGREES EARNED)
   CHECK WHEN YOU CAN WORK & INDICATE HOURS
High School

 College

 Other
   REFERENCES
Please list three references (not including relatives)
    Relationship                                   Name                                                     Phone                                  Years known
   PREVIOUS EMPLOYMENT
Company                                                                                               Phone

Address                                                                                                 Supervisor

Job Title                                                                          Starting Salary  $                                  Ending Salary  $

Responsibilities

From                         To                              Reason for Leaving

May we contact your previous supervisor for a reference?         
Company                                                                                               Phone

Address                                                                                                 Supervisor

Job Title                                                                          Starting Salary  $                                 Ending Salary  $

Responsibilities

From                         To                               Reason for Leaving

May we contact your previous supervisor for a reference?         
Company                                                                                               Phone

Address                                                                                                 Supervisor

Job Title                                                                          Starting Salary  $                                 Ending Salary  $

Responsibilities

From                         To                              Reason for Leaving

May we contact your previous supervisor for a reference?         
I certify that all the information on this application is accurate and complete to the best of my knowledge and
understand that misleading or false statements will constitute sufficient cause for refusal of hire or
termination of my employment.
Electronic Signature of Applicant
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EMPLOYMENT APPLICATION
YES NO
YES NO
YES NO
YES NO
FullTime
PartTime
YESNO
YES NO
YES NO
YES NO