First Name*
Middle Initial*
Last Name*
Phone*
Email*
Address
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip

Referred by AdvertisementAgencyPersonIn Store SignageWebsiteOther
Please Name Source (if answered other)
Are you legally eligible for employment in the USA?  Yes No
Date of Birth*
Position applying for
Salary expected
Do you have transportation to and from work?  Yes No

Were you previously employed by us  Yes No
If yes, when
Other name(s) used while attending schools or places of employment indicated on this form

Can you perform the functions of this job with or without reasonable accommodations  Yes No
If No, please explain
Have you ever been convicted of a felony  Yes No
If yes, please explain (A conviction alone will not automatically bar you from employment)

High School

Name and Location
Course of Study
Currently Enrolled  Yes No
What year did you / do you plan to graduate

College

Name and Location
Course of Study
Currently Enrolled  Yes No
What year did you / do you plan to graduate
Degree

Other

Name and Location
Course of Study
Currently Enrolled  Yes No
What year did you / do you plan to graduate
Degree

Military

Military Service  Yes No
Brach of service and rank
Dates of Service
Special Training

Current / Most Recent Employer

Name of Company
Address
Supervisor
Salary
Phone
Job Title
Date Started
Date Left
Job Description
Reason for Leaving ---Still ThereLayed OffQuitFired
Explain

Second Most Recent Employer

Name of Company
Address
Supervisor
Salary
Phone
Job Title
Date Started
Date Left
Job Description
Reason for Leaving ---Still ThereLayed OffQuitFired
Explain

Third Most Recent Employer

Name of Company
Address
Supervisor
Salary
Phone
Job Title
Date Started
Date Left
Job Description
Reason for Leaving ---Still ThereLayed OffQuitFired
Explain

First Reference

Name
Relationship to Reference
Occupation
Address
Phone

Second Reference

Name
Relationship to Reference
Occupation
Address
Phone

Third Reference

Name
Relationship to Reference
Occupation
Address
Phone

Please summarize any additional information necessary to fully describe your qualifications.

PLEASE READ All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts in this application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment offer is contingent upon satisfactory references and I authorize Fox Harbor Pub and Grill to investigate past employment and education history, as well as references given on application.

I understand that if employed such employment may be terminated for just cause, or no cause, by management at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its management, and then only when in writing and signed by the management, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

I fully understand and agree to all statements above.