Date:
Position Applied For:
Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip:
Phone:
Social Sec:
Email:
Are you a citizen of the United States?
Yes
No
Are you 19? State law requires persons to be 19 years of age to serve alcohol:
Yes
No
Have you ever been convicted of a felony?
Yes
No
Education:
Name/Location:
Years Attended:
Graduated?
Major
High School
Yes
No
College / Trade
Yes
No
Other
Yes
No
Former Employers:
Month and Year:
Name and Address:
Supervisor and Phone #
Position Worked
Reason for Leaving
From:
To:
From:
To:
From:
To:
Personal References:
Name:
Address and Phone:
Business:
Years Known:
Availability:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Day:
Night:
Do you own reliable transportation?
Yes
No
Do you smoke?
Yes
No
If so, can you work a full shift without smoking?
Yes
No
Please list any physical disabilities you are aware of that may prevent you from fulfilling any job duties required:
Please list any special talents / training that can contribute to your position:
Upload your resume or picture here (required):
Employment Certification and Verification:
For your application to be considered, the following statement must be read and understood fully:
I understand and agree that any omission, misrepresentation or misstatement of material fact in this application and/ or attached resume (if any) may result in refusal of or termination of employment. If hired, my employment may be terminated at any time with or without cause or notice, at the option of either my employer or myself.
I authorize McDuffy's or its agents to verify all information provided by me on this application or in support of my efforts to obtain employment within McDuffy's and to obtain any information relating to employment with you. I agree to hold McDuffy's and its agents harmless and absolve from any and all liability.
I have read and understand the terms and conditions as listed above.
