Employment with Family Pancake House

Please fill out the form below and submit when completed. We will contact you shortly after receiving your application.

Position applying for
	Note: A seperate application is required for each position you are applying.

Contact Information

First Name
Middle Name
Last Name

Home Address
Address
City
State
Zip/Postal Code

Telephone Numbers
Telephone 1	Type
Telephone 2	Type

E-mail
E-mail address

Personal Information

Date you are available to start work

Wage or salary desired $

If hired, would you have a reliable means of transportation to and from work?

Are you at least 18 years old?

Are you available to work?

	Fulltime		Parttime		Seasonal
	Weekends		Holidays		Overtime

Education
School 1
Kind of school
Name of school
City
State
Subjects studied
Dates attended	to
Did you graduate?
Degree type

School 2
Kind of school
Name of school
City
State
Subjects studied
Dates attended	to
Did you graduate?
Degree type

School 3
Kind of school
Name of school
City
State
Subjects studied
Dates attended	to
Did you graduate?
Degree type

Employment History
Current or Most Recent Employer
Name of employer
Address
City
State/Province
Zip/Postal Code
Job title
Your duties
Dates of employment	to
Starting pay
Ending pay
Reason for leaving
Name of supervisor
Supervisor’s title
Supervisor’s phone
May we contact your supervisor?

Previous Employer
Name of employer
Address
City
State/Province
Zip/Postal Code
Job title
Your duties
Dates of employment	to
Starting pay
Ending pay
Reason for leaving
Name of supervisor
Supervisor’s title
Supervisor’s phone
May we contact your supervisor?

Previous Employer
Name of employer
Address
City
State/Province
Zip/Postal Code
Job title
Your duties
Dates of employment	to
Starting pay
Ending pay
Reason for leaving
Name of supervisor
Supervisor’s title
Supervisor’s phone
May we contact your supervisor?

Previous Employer
Name of employer
Address
City
State/Province
Zip/Postal Code
Job title
Your duties
Dates of employment	to
Starting pay
Ending pay
Reason for leaving
Name of supervisor
Supervisor’s title
Supervisor’s phone
May we contact your supervisor?

Professional References
Reference 1
Name of reference
Their relationship to you
Years known	from to
Address
City
State/Province
Zip/Postal Code
Telephone
What can this person tell us about you?

Reference 2
Name of reference
Their relationship to you
Years known	from to
Address
City
State/Province
Zip/Postal Code
Telephone
What can this person tell us about you?

Reference 3
Name of reference
Their relationship to you
Years known	from to
Address
City
State/Province
Zip/Postal Code
Telephone
What can this person tell us about you?

Additional Information

Languages
List languages, other than English, that you speak. For each language, indicate whether you are fluent, intermediate, or have basic knowledge.

Skills
List computer software you have used, or business skills such as short-hand or typing speed, or any special training you have had.

Military
List the branch of service, years of service, your current rank, or rank upon discharge, etc.

Personal/Interests
Include any additional information you would like to share with a prospective employer.

Note: We will only consider applicants for this position who:

A) Are citizens of The United States, or
B) Are currently working in The United States and have a valid work permit. Applicants living outside The United States who have valid work permits must be willing to pay for their own interview and relocation expenses.

By applying for this position, you acknowledge that you meet the above conditions.