Employment Application Jacky's Galaxie Bristol

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Applicant Information

First Name First Name is required.

Last Name Last Name is required.

Middle Intial

Street Address Address is required.

City City is required.

State State is required.

Zip Zip is required.

Apt #

Phone # Phone is required.

Cell # Cell phone is required.

Email Address Email address is required.

Date Available

Date of Birth

Desired Salary Middle Initial is required.

Are you a citizen of the United States? Yes No

If no, are you authorized to work in the U.S? Yes No

Have you ever worked for this company? Yes No

If so, when?

Are you Alcohol Certified? Yes No

If so, when?

Have you ever been convicted of a felony? Yes No

If yes, explain

Availability

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Previous Employment

Company Name

Phone #

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Starting Date

Ending Date

Reason for leaving

Company 2

Company Name

Phone #

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Starting Date

Ending Date

Reason for leaving

Company 3

Company Name

Phone #

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Starting Date

Ending Date

Reason for leaving

Education

High School Name

Address

Starting Date

Ending Date

Did you graduate? Yes No

Degree

College Name

Address

Starting Date

Ending Date

Did you graduate? Yes No

Degree

Other Name

Address

Starting Date

Ending Date

Did you graduate? Yes No

Degree

References

Full Name

Relationship

Company

Phone #

Address

Reference 2

Full Name

Relationship

Company

Phone #

Address

Reference 3

Full Name

Relationship

Company

Phone #

Address

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Jacky's Waterplace ::: 200 Exchange St, Providence, RI 02903 (401) 383-5000

Jacky's Restaurant ::: 1488 Mineral Spring Ave. North Providence, RI 02904

Jacky's Galaxie ::: 383 Metacom Ave. Bristol, RI 02809

Jacky's Restaurant ::: 1764 Mendon Road Cumberland, RI 02864

Applicant Information

Availability

Previous Employment

Education

References

Military Service

Disclaimer